Clinical judgement of GPs for the diagnosis of dementia: a diagnostic test accuracy study
Creavin, S. T.
PublisherRoyal College of General Practitioners
Rights© 2021, The Authors.
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BACKGROUND: GPs often report using clinical judgement to diagnose dementia. AIM: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. DESIGN & 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 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median ACE-III score was 75 (IQR 65-87). 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 2.9-15) compared to people aged ?80 years (3.6, 95% CI 1.7-7.6), and in women (10.4, 95% CI 3.4-31.7) compared to men (3.2, 95% CI 1.7-6.2), 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.