Sept. 25, 2000 --- Alzheimer's disease has been called a kind of journey, though obviously not one anyone would choose to take. Because of the slowly debilitating nature of the disease, it is often the caregiver who must guide the patient through the maze of confusing and often sorrowful searching. Many caregivers turn to the family doctor to lead them, yet are these doctors really the best people to rely on for diagnosis and management of the disease?
Not always, according to a small study presented at the 52nd Annual Scientific Assembly of the American Academy of Family Physicians in Dallas.
"What was most surprising about our study is that almost 50% of the cases of dementia went undiagnosed by the primary care physician," study author Gerald D. Karetnick, BA, tells WebMD. "We also found that it took, on average, nine months before the primary caregiver took the patient to their doctor for an initial visit --- and from this point, another three years before an actual diagnosis of Alzheimer's was made." Karetnick is a fourth year medical student at the University of Medicine and Dentistry of New Jersey at the School of Osteopathic Medicine in Stratford.
In order to determine how well family doctors recognize, evaluate, and diagnose dementia, the researchers surveyed 55 caregivers of Alzheimer's patients about their experience with their primary care physicians.
Caregiver responses showed that slightly more than half of primary care physicians performed tests for the symptoms of dementia, only a quarter conducted mental status exams, and less than half referred patients to a specialist for further evaluation. Fewer than a quarter of the caregivers were given information about community services, and less than half were asked about the stress they were experiencing.
Is it the lack of time faced by doctors or the need for further education about the disease that causes their missed diagnosis? The researchers are not sure, but according to Bill Thies, PhD, vice president of medical and scientific affairs for The Alzheimer's Association in Chicago, complete communication is the key to managing the disease.
"If you have concerns about a family member, then you ought to make these concerns known to their physician in a clear and emphatic way," Thies tells WebMD. He says that a large number of doctors are aware of treatments for Alzheimer's. "And while these [treatments] cannot cure the symptoms, they may help slow their progression."
Philip D. Sloane, MD, MPH, tells WebMD that his own research on Alzheimer's shows that many family doctors, unless they frequently take care of nursing home patients, simply do not see a lot of the disease in their day-to-day practice.
"Management of Alzheimer's has become increasingly sophisticated, and so it is possible that some [doctors] are not familiar with the nuances of care, particularly the management of behavioral problems and the use of community resources," Sloane says. "But, I suspect that the majority of patients get very good, personal care from their family physician." Sloane is an Elizabeth and Oscar Goodwin distinguished professor of family medicine and co-director of the program on aging, disablement, and long-term care in the Cecil G. Sheps Center for Health Services Research at the University of North Carolina in Chapel Hill.
Although theories on how to best diagnose and manage a disease that affects over 12 million worldwide vary, Karetnick says his study presents one common goal: the need to gain a better sense of Alzheimer's and those who are affected by it.