Samuel Thomas Creavin1, Judy Haworth1, Mark Fish2, Sarah Cullum3, Anthony Bayer4, Sarah Purdy1, Yoav Ben-Shlomo1. 1. Population Health Sciences, University of Bristol, Bristol, United Kingdom. 2. Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom. 3. Depatment of Psychological Medicine, School of Medicine, The University of Auckland, Grafton, New Zealand. 4. School of Medicine, Cardiff University, Cardiff, United Kingdom.
Abstract
BACKGROUND: GPs often report using clinical judgement to diagnose dementia. AIM: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. DESIGN & SETTING: Diagnostic test accuracy study, recruiting from 21 practices around Bristol. METHOD: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia. RESULTS: 240 people were recruited, with a median age of 80 years (IQR 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median ACE-III score was 75 (IQR 65-87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9-15) compared to people aged ≥80 years (3.6, 95% CI 1.7-7.6), and in women (10.4, 95% CI 3.4-31.7) compared to men (3.2, 95% CI 1.7-6.2), whereas the negative likelihood ratio was similar in all groups. CONCLUSION: A GP clinical judgement of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people who GPs judge as not having dementia.
BACKGROUND: GPs often report using clinical judgement to diagnose dementia. AIM: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. DESIGN & SETTING: Diagnostic test accuracy study, recruiting from 21 practices around Bristol. METHOD: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia. RESULTS: 240 people were recruited, with a median age of 80 years (IQR 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median ACE-III score was 75 (IQR 65-87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9-15) compared to people aged ≥80 years (3.6, 95% CI 1.7-7.6), and in women (10.4, 95% CI 3.4-31.7) compared to men (3.2, 95% CI 1.7-6.2), whereas the negative likelihood ratio was similar in all groups. CONCLUSION: A GP clinical judgement of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people who GPs judge as not having dementia.
Authors: Samuel T Creavin; Anna H Noel-Storr; Ryan J Langdon; Edo Richard; Alexandra L Creavin; Sarah Cullum; Sarah Purdy; Yoav Ben-Shlomo Journal: Cochrane Database Syst Rev Date: 2022-06-16