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Quantifying the diagnostic pathway for patients with cognitive impairment: real-world data from Australia

Published online by Cambridge University Press:  25 November 2019

Christopher M. Black ,
Michael Woodward ,
Baishali M. Ambegaonkar ,
Alana Philips ,
James Pike ,
Eddie Jones ,
Joseph Husbands  and
Rezaul K. Khandker
Christopher M. Black*
Affiliation:
Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
Michael Woodward
Affiliation:
Aged Care Services and Head, Aged Care Research, Memory and Wound Clinics, Austin Health, Heidelberg, Victoria, Australia
Baishali M. Ambegaonkar
Affiliation:
Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
Alana Philips
Affiliation:
MSD, Sydney, NSW, Australia
James Pike
Affiliation:
Adelphi Real World, Macclesfield, UK
Eddie Jones
Affiliation:
Adelphi Real World, Macclesfield, UK
Joseph Husbands
Affiliation:
Adelphi Real World, Macclesfield, UK
Rezaul K. Khandker
Affiliation:
Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
*
Correspondence should be addressed to: Christopher M. Black, Outcomes Research, Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA. Phone: +732 594-3037. Email: christopher.black2@merck.com.
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Abstract

Objectives:

Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia.

Design:

A real-world, cross-sectional survey of physicians and patients.

Setting:

Clinical practice.

Participants:

Primary care or specialist physicians managing patients with cognitive impairment (CI).

Measurements:

Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors.

Results:

Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 ± 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 ± 7.4 months (1.2 ± 3.6 months if not referred to a secondary physician, and 5.3 ± 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients.

Conclusions:

A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.

Keywords

caregiverscognitive impairmentearly diagnosisprodromalreal-world
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 5: Issue Theme: Challenges and Facilitators for Diagnosis and Treatment of Dementia , May 2020 , pp. 601 - 610
Copyright
© International Psychogeriatric Association 2019

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