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Time to diagnosis in younger-onset dementia and the impact of a specialist diagnostic service

Published online by Cambridge University Press:  28 August 2020

Samantha M. Loi*
Affiliation:
Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria3050, Australia Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Grattan Street, Parkville, Victoria3052, Australia
Anita M.Y. Goh
Affiliation:
Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria3050, Australia Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Grattan Street, Parkville, Victoria3052, Australia National Ageing Research Institute, Poplar Road, Parkville, Victoria3052, Australia
Ramon Mocellin
Affiliation:
Delmont Private Hospital, Glen Iris, Victoria3146, Australia
Charles B. Malpas
Affiliation:
Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Victoria3050, Australia Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria3050, Australia
Shaun Parker
Affiliation:
Monash Health, Clayton, Victoria3169, Australia
Dhamidhu Eratne
Affiliation:
Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria3050, Australia Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Grattan Street, Parkville, Victoria3052, Australia
Sarah Farrand
Affiliation:
Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria3050, Australia
Wendy Kelso
Affiliation:
Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria3050, Australia Department of Psychology, Monash University, Clayton, Victoria3168, Australia
Andrew Evans
Affiliation:
Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria3050, Australia
Mark Walterfang
Affiliation:
Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria3050, Australia Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Grattan Street, Parkville, Victoria3052, Australia Florey Institute of Neuroscience and Mental Health, Parkville, Victoria3052, Australia
Dennis Velakoulis
Affiliation:
Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria3050, Australia Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Grattan Street, Parkville, Victoria3052, Australia
*
Correspondence should be addressed to: Dr. Samantha M. Loi, Neuropsychiatry, John Cade Level 2, Royal Melbourne Hospital, Parkville, Victoria3050, Australia. Phone: +3 9342 8750. Fax: +3 9342 8483. Email: Samantha.loi@unimelb.edu.au.

Abstract

Objectives:

While early diagnosis of younger-onset dementia (YOD) is crucial in terms of accessing appropriate services and future planning, diagnostic delays are common. This study aims to identify predictors of delay to diagnosis in a large sample of people with YOD and to investigate the impact of a specialist YOD service on this time to diagnosis.

Design:

A retrospective cross-sectional study.

Setting:

The inpatient unit of a tertiary neuropsychiatry service in metropolitan Victoria, Australia.

Participants:

People diagnosed with a YOD.

Measurements and methods:

We investigated the following predictors using general linear modeling: demographics including sex and location, age at onset, dementia type, cognition, psychiatric diagnosis, and number of services consulted with prior to diagnosis.

Results:

A total of 242 inpatients were included. The mean time to diagnosis was 3.4 years. Significant predictors of delay included younger age at onset, dementia type other than Alzheimer’s disease (AD) and behavioral-variant frontotemporal dementia (bvFTD), and increased number of services consulted. These predictors individually led to an increased diagnostic delay of approximately 19 days, 5 months, and 6 months, respectively. A specialized YOD service reduced time to diagnosis by 12 months.

Conclusion:

We found that younger age at onset, having a dementia which was not the most commonly occurring AD or bvFTD, and increasing number of services were significant predictors of diagnostic delay. A novel result was that a specialist YOD service may decrease diagnostic delay, highlighting the importance of such as service in reducing time to diagnosis as well as providing post-diagnostic support.

Type
Original Research Article
Copyright
© International Psychogeriatric Association 2020

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