title: Who refuses the diagnostic assessment for dementia in primary care?
abstract: OBJECTIVE
  Early screening and detection of dementia in primary care remains controversial. At least half of the patients identified as cognitively impaired by screening instruments do not meet criteria for dementia and some patients refuse further evaluation following a positive screen. The aim of this study was to identify the characteristics of patients who refuse a clinical diagnostic assessment for dementia after screening.
  
  
  METHODS
  Cross sectional study.
  
  
  METHODS
  Seven primary care practice centers in Indianapolis.
  
  
  METHODS
  Four hundred and thirty-four individuals aged 65 and older who screened positive for dementia with a mean age of 74.6, 67% women, and 68% African-American.
  
  
  METHODS
  Patients' acceptance of undergoing a dementia diagnostic assessment that included neuropsychological testing, caregiver interview, and medical chart review.
  
  
  RESULTS
  Among patients with positive screening results for dementia, approximately half (47.7%) refused further assessment to confirm their screening results. In a bivariate analysis, possible factors associated with a higher probability of refusing dementia assessment were older age and better screening score. In a multiple logistic regression model, performing well on the temporal orientation of the screening instrument was associated with a higher probability of refusing diagnostic assessment for dementia (OR = 1.37; p = 0.001). Also, African-American patients aged 80 and older were more likely to refuse the diagnostic assessment than African-Americans less than 80 years of age (OR = 3.1, p < 0.001), while there was no significant age association for white patients (OR = 0.9, p = 0.728).
  
  
  CONCLUSIONS
  Older primary care patients who perceived themselves as having no cognitive symptoms refused dementia diagnostic assessment despite their positive screening results. We must improve our understanding of the decision-making process driving patients' beliefs and behaviors about the benefits and risks of dementia screening and diagnosis before implementing any broad-based screening initiatives for dementia.
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN 46202-2872, USA. mboustani@regenstrief.org
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.forename: Fred
authors.initials: F
authors.lastname: Unverzagt
authors.forename: Mary Guerriero
authors.initials: MG
authors.lastname: Austrom
authors.forename: Bridget
authors.initials: B
authors.lastname: Fultz
authors.forename: Siu
authors.initials: S
authors.lastname: Hui
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Hendrie
mesh_terms: D001741:Black or African American / Q000523:psychology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003704:Dementia / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007196:Indiana; D008297:Male; D008403:Mass Screening / Q000523:psychology; D009483:Neuropsychological Tests; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D011320:Primary Health Care; D044465:White People / Q000523:psychology