Dementia Recognition and Cognitive Performance in Relation to Elderly Patients’ Social Integration
DOI: 10.3238/zfa.2017.0305-0311german translation / full article
Background: A German study on dementia (Ageing, Cognition and Dementia in Primary Care Patients, AgeCoDe) found that family practitioners (FPs) identify mild dementia less frequently in patients without a partner. The reasons for this are unknown. This article deals with two questions: 1) Does FPs’ recognition of dementia relate to a patient’s partner status in particular or to the overall social integration (partner, family/friends, social activities)? 2) Is the cognitive performance of a patient dependent on partner status and level of social integration (as a possible reason for differences in dementia recognition)?
Methods: Data from a subsample of the prospective cohort study AgeCoDe were explored. FP patients between 75 and 89 years of age were interviewed at home by researchers. The interview included cognitive testing and the application of the social integration index (SII) in questions about the patients’ partner status, level of contact with friends and family members, and social activities. Diagnostic reference was constituted by the clinical dementia diagnosis based on interview results and consensus meetings with interviewers and experts. Independent of these clinical interviews, the participating patients’ FPs completed a questionnaire about each patient, which included ratings on the patient’s cognitive status and dementia (Global Deterioration Scale). Concordance between FP ratings and the reference diagnosis revealed sensitivity and specificity of the FP judgement for dementia recognition. To answer question 1), two multi-level analyses were carried out with the target variable of missed or overestimated dementia and the predictors of social integration/partner status, gender, education, and global cognitive performance. To answer question 2), groups of patients with varied levels of social integration were compared with regard to several cognitive abilities, using bivariate group comparisons.
Results: A sample of 91 patients with incident dementia and a sample of 743 patients without dementia were analysed. 1) Partner status, but not overall social integration, is an independent predictor of FPs’ dementia recognition. 2) Dementia patients without partner but with high level of social integration display inferior performance in tasks of verbal intellectual ability. In the non-dementia sample, those with high level of social integration and with partner show least depressiveness; patients with a partner display a lower level of everyday functionality.
Conclusions: It is specifically the partner status of a patient, rather than the overall social integration, that impacts FPs’ ability to identify dementia. There is no indication that poor recognition can be explained by patients without partner being cognitively more intact. A resulting hypothesis is that the lack of diagnostic information from a partner can impede FPs’ recognition of dementia. Consideration of partner status as a factor in FP dementia recognition and of verbal intellectual ability as a relevant cognitive domain may be helpful in any future research on FPs’ diagnostic judgement and cognitive testing.