Opportunities of Early Diagnosis of Dementia and Critical Points in the General Practice Setting. A Retrospective Cohort Study Based on an Italian Primary Care Model

Some studies such as EVIDEM-ED (Evidence based Interventions in Dementia in the community-Early Diagnosis) [1,2] or TRELONG (Treviso Longeva Study) [3] have highlighted the importance of early screening in the aged population for the timely diagnosis of dementia, the process of which in Primary Care is still delayed. The General Practitioner (GP) represents the first step in the value chain: they will identify in their practice [4], patients at risk or who demonstrate a suspected dementing disease, they study them (imaging, blood test) [5] and they refer them to UVA (Unit for Evaluation of Alzheimer’s) for the diagnostic-therapeutic follow-up inspections [6,7].

We wanted to confirm GP’s attitude and management system in the dementia field: 20 GPs (17311 patients) have been interviewed and management procedures and timetables have been examined.

All the GPs worked with multiple management software: 6 among them used FPF®, 5 MilleWin®, 4 Perseo®, 3 Profim®, 2 Medico 2000®; 1 GP used them only for prescriptions and notepapers for the left over clinic evaluation; 4 GPs used a computer program also as assistance for clinical governance (3 are part of research network Health Search, 1 employs GPG® software), 1 often made self-audit. All the interviewees were privy to UVA, to their allocation and how to use it. Most GPs (60%) referred the suspect dementia patient directly to UVA without doing a blood test; 3 GPs had prescribed at least one imaging exam (computed tomography, CT; magnetic resonance imaging-MRI-of the brain) before the referral: This also has repercussions on UVA workload: waiting lists extend beyond 6 months for medical examination; staff shortages can occur; closure in the placement of new patients within UVA for Lazio Region; difficulties for relatives to accompany patients for each visit. The database inspection showed 79 patients with a dementia encodes diagnosis. It is important to note that 3 of the GPs proceeded with a detailed patient evaluation, for example using the Multidimensional Geriatric Assessment, Mini-mental State Examination or Short Portable Mental Status Questionnaire, (2 of these GPs are working with “Health Search” network) making use of MilleWin® software (Figure 1).

Figure 1: Screenshot of a General Practice Program. Scores and scales are clearly visible, including those for assessing dementia.

1. Contemporary Demographic Policy (2007) Russia and foreign experience, analytical bulletin of the federation council of the federal assembly of the Russian federation. No. 25, (in Russian).
2. https://www.cia.gov/libarary/ publications/the-world-factbook/geos/us.html
3. UN population division world population prospects.
4. USA quick facts from the US census bureau.
5. (2015) United nations, department of economic and social affairs, population division.
6. (2015) World population prospects. The 2015 Revision, DVD Edition. File POP/8-1.
7. Anikin AV, Malthusianism (1975) Youth of science: Life and ideas of thinkers-economists before Marx. In: (2^nd edn), Politizdat, Moscow, Russia, pp. 266-274.
8. Viktorov AA, Kholodnov VA (2020) Analysis and forecast based on the kinetic equation for changing the numerical composition of living systems. Gerontology & Geriatric Studies 5(5): 542-548.
9. Kapitsa S (1999) Model of earth's population growth and economic progress of mankind. Economic issues, No. 12.
10. Kapitsa S (1999) How many people lived, lives and will live on the Earth. Nauka, Moscow, Russia.
11. Foerester H, Mora P, Amiot L (1960) Doomsday: Friday, 13 November, A.D. 2026. At this date human population will approach infinity if it grows as it has grown in the last two millennia, Science 132: 1291-1295.
12. Hoerner S (1975) Population explosion and interstellar expansion. Journal of the British Interplanetary Society 28: 691-712.
13. Кrеmеr M (1993) Population growth and technological change: One Million B.C. to 1990. The Quarterly Journal of Economics, 108: 681-716.
14. Verhulst PF (1845) Recherches Mathématiques sur La Loi D’Accroissement de la Population. Nouveaux Mémoires de l’Académie Royale des Sciences et Belles-Lettres de Bruxelles, 18, Art-1, pp. 1-45.
15. Orlov YN (2015) Methods of mathematical demography: state-of-the-art, problems, exact results. Keldysh Institute of Applied Mathematics RAS, MIPT, sector of kinetic equations, department of higher mathematics, KIT, Kotovsk, Russia.
16. Staroverov OV (1997) The basics of mathematical demography. Nauka, Moscow, Russia.
17. Selye G (1982) Stress without distress. In: (1^st edn), Progress Publisher, Moscow, Russia.