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- Dokumenttyp:
- Article; Journal Article
- Autor(en):
- 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
- Titel:
- The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice.
- Abstract:
- BACKGROUND: Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse. AIM: 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. DESIGN AND SETTING: Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016. METHOD: 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. RESULTS: 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). CONCLUSION: 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.
- Zeitschriftentitel:
- Br J Gen Pract
- Jahr:
- 2019
- Band / Volume:
- 69
- Heft / Issue:
- 688
- Seitenangaben Beitrag:
- e786-e793
- Volltext / DOI:
- doi:10.3399/bjgp19X706037
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/31594770
- Print-ISSN:
- 0960-1643
- TUM Einrichtung:
- Klinik und Poliklinik für Psychiatrie und Psychotherapie
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