title: Factors associated with primary care physicians' recognition of cognitive impairment in their older patients.
abstract: Although there are accurate screens for cognitive impairment, there is as yet no evidence that screening improves outcomes including primary care physicians' (PCP) medical decision making. PCPs' recognition of cognitive impairment being suboptimal, we investigated factors associated with improved recognition. Eligible patients were aged 65 years and above, without documented dementia or previous work-up for dementia, seen consecutively over 2 months by one of 13 PCPs. PCPs indicated whether they, the patient, or the family had concerns about each patient's cognition. We enrolled 130 patients with any cognitive concerns and a matched sample of 133 without cognitive concerns, and administered standardized neuropsychological tests. PCP's judgments of cognitive concern showed 61% sensitivity and 86% specificity against the neuropsychological standard. When combined with a Mini-Mental State Examination score ≤26, PCP recognition improved in sensitivity (82%) with some loss in specificity (74%). True positives increased when PCPs' practices included more cognitively impaired patients and when patients reported poor memory. False positives increased when patients had diabetes, reported poor memory, or no or light alcohol consumption. Medical decision making can be improved by the Mini-Mental State Examination and greater exposure to cognitively impaired patients, but knowledge of certain risk factors for cognitive impairment negatively affected these decisions.
authors.affiliation: *Department of Family & Community Medicine ∥Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto †Primary Care Research Unit, Sunnybrook Health Sciences Centre ‡Department of Medicine and Rotman Research Institute, Baycrest Health Sciences §Research Department, Toronto Rehabilitation Institute, University Health Network ¶Institute for Clinical Evaluative Sciences, Toronto, ON, Canada #Departments of Psychiatry and Neurology, School of Medicine **Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Tierney
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
authors.forename: Ross
authors.initials: R
authors.lastname: Upshur
authors.forename: Liisa
authors.initials: L
authors.lastname: Jaakkimainen
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Charles
authors.forename: Mary
authors.initials: M
authors.lastname: Ganguli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D058007:Physicians, Primary Care