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Primary Care Physicians' Diagnostic, Management, and Referral Practices for Older Persons and Families Affected by Dementia

Case Western Reserve University

Al Leighton

University of Southern Maine

John H. Wasson

Dartmouth College

As the size of the older population increases, primary care physicians can expect to see growing numbers of patients who present with symptoms of cognitive dysfunction. This study examines how office-based primary care physicians in three states (N = 498) diagnose and manage dementia symptoms using clinical vignettes portraying a 72-year-old woman with either mild or moderate dementia symptoms and her adult daughter. Physicians were more likely to order a variety of laboratory tests than to perform mental and cognitive status tests as part of a diagnostic workup. Respondents also were much more likely to disclose a diagnosis of probable Alzheimer's disease to the daughter in the vignette than to her mother. Differences in reported dementia management behaviors were found according to physician specialty, number of years in practice, and experience with patients with dementia in actual practice. Results suggest that whereas primary care physicians can play a valuable role in the service system for families affected by dementia, barriers must be overcome to improve specific aspects of their diagnostic and management behaviors.

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