We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice.
- Authors
Pentzek, Michael; Wagner, Michael; Abholz, Heinz-Harald; Bickel, Horst; Kaduszkiewicz, Hanna; Wiese, Birgitt; Weyerer, Siegfried; König, Hans-Helmut; Scherer, Martin; Riedel-Heller, Steffi G; Maier, Wolfgang; Koppara, Alexander; AgeCoDe Study Group; van den Bussche, Hendrik; Brettschneider, Christian; Bachmann, Cadja; Blank, Wolfgang; Eifflaender-Gorfer, Sandra; Eisele, Marion; Ernst, Annette
- Abstract
<bold>Background: </bold>Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.<bold>Aim: </bold>To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing dementia.<bold>Design and Setting: </bold>Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.<bold>Method: </bold>Patients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.<bold>Results: </bold>A total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor-patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient's memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs' baseline judgements were significantly associated with patients' 12-year dementia-free survival rates (Mantel-Cox log rank test P<0.001).<bold>Conclusion: </bold>In this sample of patients in familiar doctor-patient relationships, the GP's clinical judgement holds additional value for predicting dementia, complementing test performance and patients' self-reports. Existing and emerging primary care-based dementia risk models should consider the GP's judgement as one predictor. Results underline the importance of the GP-patient relationship.
- Publication
British Journal of General Practice, 2019, Vol 69, Issue 688, pe786
- ISSN
0960-1643
- Publication type
journal article
- DOI
10.3399/bjgp19X706037