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(Ivanhoe Newswire) A doctor's positive attitude to Alzheimer's diagnosis and his or her trusting, personal relationships with local dementia support service providers are powerful support for early diagnosis of Alzheimer's, according to new research.
While currently there is no cure for Alzheimer's, early detection and diagnosis is critical to ensure that people living with Alzheimer's have the power to plan their own healthcare and future, according to the Alzheimer's Association. Current data suggests fewer than 35 percent of people with Alzheimer's or other dementias have a diagnosis of the condition in their medical record.
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"By getting diagnosed late in the progression of the disease, opportunities are missed to make key decisions about treatment, care and, future planning. Being diagnosed early is vital to receiving the best help and care possible, living one's life to the fullest, and capitalizing on opportunities such as participating in clinical studies," William Thies, Ph.D., Chief Medical & Scientific Officer at the Alzheimer's Association was quoted as saying.
Dr. Nerida Paterson, Senior Lecturer in the Discipline of General Practice at the University of Newcastle, Australia, and colleagues are interviewing more than 100 general practitioners (GPs) from four Australian research sites, searching for insights that can improve the diagnostic process.
"Increasing evidence suggests that early diagnosis of Alzheimer's and timely intervention is beneficial, both for people with the disease and for their caregivers," Paterson is quoted as saying. "Because doctors are the primary entry way to healthcare services for the elderly and the usual point of contact with the health system for individuals with dementia and their caregivers, there remains a need to overcome their attitudes of 'therapeutic nihilism' surrounding dementia."
Paterson described "therapeutic nihilism" as the belief that since there is no recognized cure or effective treatment for an illness, treatment or intervention in any form is not important.
According to Paterson, the most important element in early Alzheimer's diagnosis is a doctor's positive attitude to the diagnosis and treatment of dementia. GPs reported having a trusting, personal relationship with individuals who provide dementia support services also plays a significant role in early dementia diagnosis and management. Most of the GPs reported that referral to support services for legal and financial planning, patient education, and caregiver support is essential to effective disease management.
Researchers found the most frequently cited barriers to diagnosis of dementia in this study are the differing priorities of patients and doctors. GPs must depend on either the patient or a relative to alert them to symptoms of dementia. GPs alluded to challenges with proper timing of referral to support services. GPs also reported that they feared damaging the doctor-patient relationship, especially around the issue of declaring the patient unable to drive safely.
"Older patients frequently have complex and overlapping illnesses involving multiple body systems. Often these diseases are having a bigger impact on their day to day lives than mild cognitive impairment, Paterson said. As a result, when they see the doctor, their priority is to have their non-cognitive health needs addressed."
If a patient appeared to be functioning well, GPs in this study were less likely to suspect cognitive impairment. GPs reported that a cognitive deficit is more often brought to their attention by a relative or caregiver than by the patient. Such an informant is seen as vital for early diagnosis.
GPs reported they find it hard to remember to re-offer referral to support services. GPs suggest these services to patients soon after the diagnosis. However, patients and caregivers are adjusting to the diagnosis at this time and may be suffering from denial, anger and guilt, and will often reject the referral. When they are ready to accept support, the GP may be unaware that their attitudes have changed.
The researchers recommend doctors be educated to have a higher level of suspicion for symptoms of cognitive decline, especially in caregivers and in people with complex, multi-system diseases. They suggest that GPs offer referrals to support services for people with dementia and caregivers on multiple occasions during the diagnostic and treatment process. A literature review conducted by the same researchers reinforced these themes and suggested that the involvement of practice and community nurses in the diagnostic process may overcome some of the barriers and improve detection rates.
SOURCE: Research reported at the 2009 International Conference on Alzheimer's Disease (ICAD 2009) in Vienna, Austria, July 12, 2009
If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Melissa Medalie at mmedalie@ivanhoe.com
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