Effect of Early Referral to Specialist in Dementia on Institutionalization and Functional Decline: Findings from a Population-Based Study.
BACKGROUND
Although early diagnosis has been hypothesized to benefit both patients and caregivers, until now studies evaluating the effect of early dementia diagnosis are lacking.


OBJECTIVE
To investigate the influence of early specialist referral for dementia on the risk of institutionalization and functional decline in Activity of Daily Living (ADL).


METHODS
Incident dementia cases were screened in a prospective population-based cohort, the Three-City Study, and initial specialist consultation for cognitive complaint was assessed at dementia diagnosis. Proportional hazard regression and illness-death models were used to test the association between specialist referral and, respectively, institutionalization and functional decline.


RESULTS
Only one third of the incident individuals with dementia had consulted a specialist for cognitive problems early (36%). After adjustment on potential confounders (including cognitive and functional decline) and competing risk of death, participants who had consulted a specialist early in the disease course presented a higher rate of being institutionalized than those who did not (Hazard Ratio = 2.00, 95% Confidence Interval (CI): 1.09- 3.64). But early specialist referral was not associated with further functional decline (HR = 1.09, 95% CI: 0.71- 1.67).


CONCLUSIONS
Early specialist referral in dementia is associated with increased risk of institutionalization but not with functional decline in ADL. These findings suggest that early care referral in dementia may be a marker of concern for patients and/or caregivers; subsequent medical and social care could be suboptimal or inappropriate to allow patients to stay longer at home.
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.|University of Bordeaux, Bordeaux, France.
Clément
C
Pimouguet
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.|University of Bordeaux, Bordeaux, France.
Mélanie
M
Le-Goff
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Debora
D
Rizzuto
INSERM U1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Université de Montpellier, Montpellier, France.
Claudine
C
Berr
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.|University of Bordeaux, Bordeaux, France.
Karen
K
Leffondré
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.|University of Bordeaux, Bordeaux, France.
Karine
K
Pérès
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.|University of Bordeaux, Bordeaux, France.|Service de Neurologie, Department of Clinical Neurosciences, CHU Pellegrin, Bordeaux, France.
Jean FranÇois
JF
Dartigues
INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.|University of Bordeaux, Bordeaux, France.|INSERM, Clinical Investigation Center - Clinical Epidemiology 7, Bordeaux, France.
Catherine
C
Helmer
D000203:Activities of Daily Living / Q000523:psychology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D018672:Community Health Planning; D003704:Dementia / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007326:Institutionalization; D008297:Male; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D013038:Specialization
Dementia; dependency; institutionalization; population-based study; secondary care