The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice

TY - JOUR

T1 - The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice

AU - Pentzek, Michael

AU - Wagner, Michael

AU - Abholz, Heinz-Harald

AU - Bickel, Horst

AU - Kaduszkiewicz, Hanna

AU - Wiese, Birgitt

AU - Weyerer, Siegfried

AU - König, Hans-Helmut

AU - Scherer, Martin

AU - Riedel-Heller, Steffi G

AU - Maier, Wolfgang

AU - Koppara, Alexander

AU - AgeCoDe Study Group

N1 - © British Journal of General Practice 2019.

PY - 2019/11

Y1 - 2019/11

N2 - BACKGROUND: Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.AIM: To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing dementia.DESIGN AND SETTING: Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.METHOD: Patients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.RESULTS: A total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor-patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient's memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs' baseline judgements were significantly associated with patients' 12-year dementia-free survival rates (Mantel-Cox log rank test P<0.001).CONCLUSION: In this sample of patients in familiar doctor-patient relationships, the GP's clinical judgement holds additional value for predicting dementia, complementing test performance and patients' self-reports. Existing and emerging primary care-based dementia risk models should consider the GP's judgement as one predictor. Results underline the importance of the GP-patient relationship.

AB - BACKGROUND: Clinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.AIM: To ascertain whether a GP's global clinical judgement of future cognitive status has an added value for predicting a patient's likelihood of experiencing dementia.DESIGN AND SETTING: Multicentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.METHOD: Patients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.RESULTS: A total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor-patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient's memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs' baseline judgements were significantly associated with patients' 12-year dementia-free survival rates (Mantel-Cox log rank test P<0.001).CONCLUSION: In this sample of patients in familiar doctor-patient relationships, the GP's clinical judgement holds additional value for predicting dementia, complementing test performance and patients' self-reports. Existing and emerging primary care-based dementia risk models should consider the GP's judgement as one predictor. Results underline the importance of the GP-patient relationship.

U2 - 10.3399/bjgp19X706037

DO - 10.3399/bjgp19X706037

M3 - SCORING: Journal article

C2 - 31594770

VL - 69

SP - e786-e793

JO - BRIT J GEN PRACT

JF - BRIT J GEN PRACT

SN - 0960-1643

IS - 688

ER -