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Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries

  • Ferdinando Petrazzuoli (a1), Shlomo Vinker (a2), Tuomas H. Koskela (a3), Thomas Frese (a4), Nicola Buono (a5), Jean Karl Soler (a6), Jette Ahrensberg (a7), Radost Asenova (a8), Quintí Foguet Boreu (a9), Gülsen Ceyhun Peker (a10), Claire Collins (a11), Miro Hanževački (a12), Kathryn Hoffmann (a13), Claudia Iftode (a14), Donata Kurpas (a15), Jean Yves Le Reste (a16), Bjørn Lichtwarck (a17), Davorina Petek (a18), Daniel Pinto (a19), Diego Schrans (a20), Sven Streit (a21), Eugene Yee Hing Tang (a22), Athina Tatsioni (a23), Péter Torzsa (a24), Pemra C. Unalan (a25), Harm van Marwijk (a26) and Hans Thulesius (a1)...



Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment.


Key informant survey. Setting: Primary care practices across 25 European countries. Subjects: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Main outcome measures: Two by two contingency tables with odds ratios and 95% confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs’ attitude of “trying to establish a diagnosis of dementia on their own.”


Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95% CI 2.28–5.23).


Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe.


Corresponding author

Correspondence should be addressed to: Dr Ferdinando Petrazzuoli, MD, MSc, Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, CRC, Building 28, Floor 11, Jan Waldenströms gata, 35, Skåne University Hospital 205 02 Malmö, Sweden. Phone: +4640391363; Fax: +4640391370. Email:


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Alzheimer Europe (2012). Dementia in Europe Yearbook 2012 National Dementia Strategies (diagnosis, treatment and research). Available at:; last accessed 26 February 2017.
Alzheimer Europe (2013). Dementia in Europe Yearbook 2013. Available at:; last accessed 26 February 2017.
Alzheimer Europe (2015). Dementia in Europe Yearbook 2015 “Is Europe becoming more dementia friendly?” Available at:; last accessed 26 February 2017.
Barnett, J. H., Lewis, L., Blackwell, A. D. and Taylor, M. (2014). Early intervention in Alzheimer's disease: a health economic study of the effects of diagnostic timing. BMC Neurology, 14, 101.
Batsch, N. L. and Mittelman, M. S. (2012). World Alzheimer Report 2012: overcoming the stigma of dementia. Available at:; last accessed 26 February 2017.
Bradford, A., Kunik, M. E., Schulz, P., Williams, S. P. and Singh, H. (2009). Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Disease and Associated Disorders, 23, 306314.
Brodaty, H., Low, L. F., Gibson, L. and Burns, K. (2006). What is the best dementia screening instrument for general practitioners to use? American Journal of Geriatric Psychiatry, 14, 391400.
Caruana-Pulpan, O. and Scerri, C. (2014). Practices in diagnosis, disclosure and pharmacotherapeutic management of dementia by general practitioners–a national survey. Aging and Mental Health, 18, 179186.
Chopard, G. et al. (2014). Early diagnosis of Alzheimer's disease: are we too close to the trees to see the forest? La Presse Médicale, 43, 886887.
Department of Health (2015). Prime Minister's challenge on dementia 2020. Produced by Williams Lea for the Department of Health. Available at:; last accessed 26 February 2017.
Hansen, E. C., Hughes, C., Routley, G. and Robinson, A. L. (2008). General practitioners' experiences and understandings of diagnosing dementia: factors impacting on early diagnosis. Social Science and Medicine, 67, 17761783.
Harris, D. P., Chodosh, J., Vassar, S. D., Vickrey, B. G. and Shapiro, M. F. (2009). Primary care providers' views of challenges and rewards of dementia care relative to other conditions. Journal of the American Geriatrics Society, 57, 22092216.
Hinton, L., Franz, C. E., Reddy, G., Flores, Y., Kravitz, R. L. and Barker, J. C. (2007). Practice constraints, behavioral problems, and dementia care: primary care physicians’ perspectives. Journal of General Internal Medicine, 22, 14871492.
Iliffe, S. et al. (2009). Primary care and dementia: 1. diagnosis, screening and disclosure. International Journal of Geriatric Psychiatry, 24, 895901.
Koch, T. and Iliffe, S. (2010a). Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review. BMC Family Practice, 11, 52.
Koch, T. and Iliffe, S. (2010b). The role of primary care in the recognition of and response to dementia. The Journal of Nutrition, Health and Aging, 14, 107109.
Kvitting, A. S., Wimo, A., Johansson, M. M. and Marcusson, J. (2013). A quick test of cognitive speed (AQT): usefulness in dementia evaluations in primary care. Scandinavian Journal of Primary Health Care, 31, 1319.
Leung, K. K. et al. (2011). Pathways to diagnosis: exploring the experiences of problem recognition and obtaining a dementia diagnosis among Anglo-Canadians. Health and Social Care in the Community, 19, 372381.
Michalowsky, B. et al. (2016). Healthcare resource utilization and cost in dementia: are there differences between patients screened positive for dementia with and those without a formal diagnosis of dementia in primary care in Germany? International Psychogeriatrics, 28, 359369.
Milne, A., Culverwell, A., Guss, R., Tuppen, J. and Whelton, R. (2008). Screening for dementia in primary care: a review of the use, efficacy and quality of measures. International Psychogeriatrics, 20, 911926.
Mori, E., Ikeda, M., Kosaka, K. and Donepezil, D. L. B. S. I. (2012). Donepezil for dementia with Lewy bodies: a randomized, placebo-controlled trial. Annals of Neurology, 72, 4152.
Parmar, J. et al. (2014). Diagnosis and management of dementia in primary care: exploratory study. Canadian Family Physician, 60, 457465.
Pentzek, M. et al. (2009). Apart from nihilism and stigma: what influences general practitioners' accuracy in identifying incident dementia? The American Journal Geriatric Psychiatry, 17, 965975
Petrazzuoli, F. et al. (2014). A quick test of cognitive speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years. International Psychogeriatrics, 18.
Pimlott, N. J. et al. (2009). Family physicians and dementia in Canada Part 2. Understanding the challenges of dementia care. Canadian Family Physician, 55, 508509. e507.
Prince, M., Wimo, A., Guerchet, M., Ali, G., Wu, Y. and Prina, M. (2015). World Alzheimer Report 2015. The Global Impact of Dementia. An Analysis Of Prevalence, Incidence, Cost and Trends. London: Alzheimer's Disease International. Available at:; last accessed 26 February 2017.
Robinson, L., Tang, E. and Taylor, J. P. (2015). Dementia: timely diagnosis and early intervention. BMJ, 350, h3029.
Tang, E. Y., Birdi, R. and Robinson, L. (2016). Attitudes to diagnosis and management in dementia care: views of future general practitioners. International Psychogeriatrics, 16.
Tang, E. Y., Burn, D., Taylor, J. P. and Robinson, L. (2015). Dementia with Lewy bodies: the emerging role of primary care. European Journal of General Practice, 15.
Turner, S. et al. (2004). General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing, 33, 461467.
Upadhyaya, A. K., Rajagopal, M. and Gale, T. M. (2010). The six item cognitive impairment test (6-CIT) as a screening test for dementia: comparison with mini-mental state examination (MMSE). Current aging science, 3, 138142.
van den Dungen, P. et al. (2014). Preferences regarding disclosure of a diagnosis of dementia: a systematic review. International Psychogeriatrics, 26, 16031618.
van den Dungen, P. et al. (2015). Dutch family physicians' awareness of cognitive impairment among the elderly. BMC Geriatrics, 15, 105.
van Hout, H., Vernooij-Dassen, M., Bakker, K., Blom, M. and Grol, R. (2000). General practitioners on dementia: tasks, practices and obstacles. Patient Education and Counseling, 39, 219225.


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