Clinical judgement of General Practitioners for the diagnosis of dementia: a diagnostic test accuracy study

Sam T Creavin, Judy Haworth, Mark Fish, Sarah J Cullum, Anthony Bayer, Sarah Purdy, Yoav Ben-Shlomo

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Abstract

Background: General Practitioners (GPs) often report using clinical judgement to diagnose dementia.

Aim: Investigate the accuracy of GPs’ clinical judgement for the diagnosis of dementia.

Design and Setting: Diagnostic test accuracy study, recruiting from 21 practices around Bristol.

Method: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia.

Results: 240 people were recruited, with a median age of 80 years (IQR 75 to 84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median
duration of symptoms was 24 months (IQR 12 to 36 months) and the median ACE-III score was 75 (IQR 65 to 87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9 to 15) compared to people aged ≥ 80 years (3.6, 95% CI 1.7 to 7.6), and in women (10.4, 95% CI 3.4 to 31.7) compared to men (3.2, 95% CI 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups.

Conclusion: A GP clinical judgement of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people who GPs judge as not having dementia.
Original languageEnglish
JournalBritish Journal of General Practice Open
Publication statusAccepted/In press - 1 Jun 2021

Keywords

  • dementia
  • general practice
  • sensitivity and specificity
  • medical history taking
  • system assessment

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