title: Traits of patients who screen positive for dementia and refuse diagnostic assessment.
abstract: BACKGROUND
  As part of the debate about screening for dementia, it is critical to understand why patients agree or disagree to diagnostic assessment after a positive screening test. We used the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire to measure the characteristics of patients who screened positive for dementia but refused further diagnostic assessment.
  
  
  METHODS
  Survey of patients ≥65 years old without a diagnosis of dementia attending primary care clinics in Indianapolis, IN, in 2008 and 2009.
  
  
  RESULTS
  Five hundred and fifty-four individuals completed the PRISM-PC and 63 screened positive. Of those, 21 (33%) accepted and 42 (67%) refused diagnostic assessment. In adjusted models, having larger stigma domain scores and living alone were significantly associated with increased odds of refusing the diagnostic assessment.
  
  
  CONCLUSIONS
  Despite screening positive, many patients refused a diagnostic assessment. Living alone and the perceived stigmas of dementia are associated with the refusal of diagnostic assessment for dementia.
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN, USA ; Regenstrief Institute, Inc., Indianapolis, IN, USA ; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Fowler
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN, USA ; Regenstrief Institute, Inc., Indianapolis, IN, USA.
authors.forename: Amie
authors.initials: A
authors.lastname: Frame
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN, USA ; Regenstrief Institute, Inc., Indianapolis, IN, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.affiliation: ] Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Sujuan
authors.initials: S
authors.lastname: Gao
authors.affiliation: Department of Health Policy and Management, Indiana University Richard M. Fairbanks, School of Public Health, Indianapolis, IN, USA.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Watson
authors.affiliation: ] Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Monahan
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN, USA ; Regenstrief Institute, Inc., Indianapolis, IN, USA ; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Malaz A
authors.initials: MA
authors.lastname: Boustani
keywords: Alzheimer's disease; Dementia screening; Diagnostic assessment; Primary care