The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice
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The value of the GP's clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice. / Pentzek, Michael; Wagner, Michael; Abholz, Heinz-Harald; Bickel, Horst; Kaduszkiewicz, Hanna; Wiese, Birgitt; Weyerer, Siegfried; König, Hans-Helmut; Scherer, Martin; Riedel-Heller, Steffi G; Maier, Wolfgang; Koppara, Alexander; AgeCoDe Study Group.
In: BRIT J GEN PRACT, Vol. 69, No. 688, 11.2019, p. e786-e793.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -