Dementia Detection In Primary Care

In the presence of signs of cognitive deterioration, it is important to consult specialized professionals. Thus, the detection of dementia in primary care can be essential to delay the course of the disease and the loss of autonomy.

In the case of cognitive deterioration, for example, it may be possible to slow down your progress.

As Pastor et al. (2003) argues, the delay in diagnosing dementia has consequences for the quality of life of patients and their families. On the other hand, the symptoms observed may be a consequence of a transient disorder, hence the importance of making a good differential diagnosis.

What does an early diagnosis of dementia entail?

According to the cited author, the  early diagnosis facilitates the identification of the etiology. This, therefore, allows for the treatment of some reversible dementias. It also facilitates the adoption of pharmacological and behavioral measures that have been shown to be effective in maintaining cognitive function.

Furthermore, it would allow the family to adapt to the new situation little by little. As the change suffered would be abrupt, being able to assimilate the illness would also represent an opportunity to reduce stress.

Warning Signs and Symptoms

According to Arenillas et al. (2018), the warning signs that we can find can be grouped into cognitive, behavioral/psychological and functional. Thus,  the main cognitive symptoms that facilitate the diagnosis of dementia in primary care would be:

• Difficulty remembering recent events, paths or names. In addition to forgetting messages and repeating the same question over and over again.
• Difficulty adapting to changes.
• Trouble finding the right words.
• Increased difficulty in performing tasks and activities that require organization and planning.

The main  behavioral or psychological symptoms that facilitate the diagnosis of dementia in primary care would be:

• Changes in personality and mood.
• Apathy or lack of motivation and initiative.
• Changes in behavior.
• Presence of psychiatric symptoms in people without a history of psychiatric problems.

The main  functional symptoms  that facilitate the diagnosis of dementia in primary care would be:

• Difficulty completing usual tasks at home, at work or during free time.

• Decrease or abandonment of personal hygiene and self-care.
• Withdrawal from work or social activities.
• Problems dealing with money.

Assessment and detection of dementia in primary care

The first professional who usually sees a person with signs of cognitive deterioration is the general practitioner. Thus, at first, when responding to the patients’ complaints, an anamnesis is carried out.

In other words, it “interrogates” the patient and his companions to find out the symptoms he presents, in addition to his medical history.

During this interview, the physician systematically gathers the data that allow him to draw up a pathology of his patient  (Redondo, V. 2017). Among other data, the anamnesis includes how and when the disease started, how the patient believes it evolved, whether he noticed changes in personality and/or behavior, etc.

Therefore, the ultimate goal of this first exam is to make a diagnostic hypothesis.

Protocol for the detection of dementia in primary care

According to Pastor et al. (2013) in the guide Claves for the detection and early intervention of dementias in primary care (Keys for the detection and early intervention of dementias in primary care, in free translation), the primary care professional should:

• First, collect personal and family history of neurological, vascular, infections and traumatic brain injuries, as well as psychiatric pathologies, comorbidities and medication use.

• Have a complete physical exam.
• Request additional exams : analytical, neuroimaging tests, cognitive screening tools, functional and neuropsychiatric assessment.

In addition, once the primary care professional has performed all of the above, he/she should evaluate the referral of the case to different specialized services:

• Neuropsychology.
• Psychiatry.
• Geriatrics.

The purpose of this referral would be to confirm some type of dementia. In these more specific areas, exams will also be carried out to facilitate the implementation of the most indicated treatment.

In conclusion, one full and personal attention is essential for the diagnosis of a disease. In this sense, multidisciplinary and interdisciplinary work is very important, especially in situations that can change people’s lives so abruptly.