Diagnóstico de demência e disfunção cognitiva em idosos na atenção primária à saúde: uma revisão sistemática

Pelegrini, Lucas N.C.; Mota, Gabriela M.P.; Ramos, Caio F.; Jesus, Edson; Vale, Francisco A.C.

doi:10.1590/1980-57642018dn13-020002

person Lucas N.C. Pelegrini

schoolPhD student on the Graduate Program in Fundamental Nursing - Nursing School of Ribeirão Preto/ University of São Paulo (EERP/USP), Ribeirão Preto, SP, Brazil.

person Gabriela M.P. Mota

schoolMaster’s student on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.

person Caio F. Ramos

schoolMaster’s student on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.

person Edson Jesus

schoolPhysical Educator, Limeira, SP, Brazil.

person Francisco A.C. Vale

schoolProfessor on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.

Lucas Pelegrini Nogueira de Carvalho. Federal University of São Carlos (UFSCar) / Department of Gerontology / DGero - Rod. Washington Luís, Km 235, SP-310 - 13565-905 São Carlos SP - Brazil. E-mail:
pelegrini_lucas@hotmail.com

Disclosure: The authors report no conflicts of interest.

Authors contributions. Lucas N.C. Pelegrini: design, selection of studies, analysis of data, intellectual contribution to the writing of the manuscript. Gabriela M.P. Mota: design, selection of studies, intellectual contribution to the writing of the manuscript. Caio F. Ramos: design, selection of studies, intellectual contribution to the writing of the manuscript. Edson Jesus: design, selection of studies, intellectual contribution to the writing of the manuscript. Francisco A.C. Vale: design, selection of studies, analysis of data, intellectual contribution to the writing of the manuscript.

First author Year, and place	Demographics (n/mean/age/gender)	Diagnosis type	Diagnostic criteria	Percentage of positive screened/diagnosed patients	Main findings
Garcia-Ptacek²⁹ 2017, Sweden	3,891 81.1 (±6.6) 63.9% Female	Dementia	GP’s evaluation; ICD-10; neuroimaging; blood testing	100%	CDT and neuroimaging are used in most of GP’s dementia diagnosis in primary health care
Grober³⁴ 2016, USA	257 75.8 69.7% Female	Dementia	DSM-IV; interview with family members or friends	25.7%	Screening based on informants to reduce false- positive rates
Noda²⁸ 2018, Japan	623 86.9 54.2% Female	Dementia	GP’s evaluation; DSM-IV	27.4%	DSM Score > I or > II reduces errors for dementia identification in primary health care
Tierney³⁵ 2014, Canada	263 77.6 (±6.9) 58.55% Male	MCI	GP’s evaluation; MMSE < 26	28.5%	MMSE would improve GP’s capacity to detect MCI in primary health care
Wilcock²⁷ 2016, England	136 79.5 64% Female	Dementia MCI	Blood testing, cognitive evaluation	100%	An update of diagnosis records for comprehensive care is needed
Chan³⁶ 2016, Singapore	309 71.7 (+-8.2) 50.2% Female	Dementia MCI	DSM-IV	21.3%	Combinations of AD8 and NINDS provided a sensitivity of 73.3% and specificity of 96.9% for dementia and MCI diagnosis, respectively
Eichler³⁷ 2014, Germany	243 79.61 (±5.44) 61 % Female	Dementia MCI	DemTect < 9; medical records	Dementia - 40% MCI-58%	Diagnosis rates for dementia in Germany are consistent with international literature
Eichler³⁸ 2015, Germany	243 >70 60.9% Female	Dementia MCI	MMSE < 23; DemTect < 9	Dementia - 49%	The diagnosis rate of dementia increased 40%
Arabi³⁹ 2016, Malaysia	200 68.5 (±6.28) 52% Female	Dementia MCI	EDQ < 5; MMSE < 21	EDQ-40% MMSE-20%	Validated questionnaire
Shaik⁴⁰ 2015, Singapore	309 71.8 (±8.2) 54.8% Female	MCI	At least one impaired cognitive domain on objective cognitive evaluation	54.8%	Risk factors identified were: age, female gender, hypertension, diabetes, hyperlipidemia and smoking
Booker⁴¹ 2016, Germany	11,956 80.4 61 % Female	Dementia	Medical Database analysis	100%	The risk factors identified were: diabetes, hypertension, obesity, hyperlipidemia, vascular diseases
Rosenbloom⁴² 2018, USA	87 77.2 (±6.2) 59.8% Female	Dementia MCI	Mini-Cog < 4/5	27.3% among screened positive on Mini-Cog	Twice the percentage previously identified with cognitive impairment
Lee⁴³ 2017, Singapore	140 72.15 (±8.42) 68% Male	MCI	MMSE; MoCA	23.5%	Just a small fraction of those considered high risk for developing dementia made use of health services
Corcoles¹⁰ 2017, Spain	104 77.8 (±6.74) 68.3% Female	MCI	MMSE	55.8%	91.4% of cases with alteration on MMSE had no history of Cognitive Impairment
Holsinger⁴⁴ 2015, USA	186 74.5 (±6.5) 96.2% Male	DementiaCIND	Medical evaluation	Dementia -12% CIND-31%	20% returned to normal cognition, 67% remained impaired, and 12% developed dementia
de Oliveira⁴⁵ 2016, Brazil	102 76.81 (±7.03) 83% Female	Dementia	DSM-IV; medical records; MMSE; CASI-S	46%	Validation of CASI-S with a 93% sensitivity and 81% specificity
Zaganas³² 2019, Greece	3,140 73.7 (±7.8) Gender: 56.8% Female	Dementia MCI	DSM-IV	Dementia-10.8% MCI-32.4%	Dementia prevalence was 4%; in primary care 60% remain undiagnosed until detailed neuropsychiatric evaluation
Pujades-Rodrigues⁴⁶ 2018, UK	47,386	Dementia	Medical records	55%	47,386 with dementia, 12,633 Alzheimer Disease, 9,540 vascular disease and 1539 with other less common causes
Malmstron⁴⁷ 2015, USA	533 65-92 100% Male	Dementia MCI	DSMIV	Dementia -12% MCI-26%	RCS sensitivity 89% and specificity 87% for detecting Dementia, compared to 94% and 70% for MCI
Stein⁴⁸ 2015, Germany	3,327 81.14 65.3% Female	Dementia	GP’s and multidisciplinary group’s evaluation; DSM-IV; SIDAM	Follow-up I - 3.2% Follow-up II - 4.62%	MMSE was more accurate than MMSE for diagnosis
Yang²⁵ 2015, China	249 67.6 61.8% Female	MCI	MMSE	Impaired cognition -12.9% MCI-41%	Simple instruments, such as MMSE and MoCA used for screening the elderly in primary health care
Shaik⁴⁹ 2016, Singapore	168 80.7 56% Female	Dementia MCI	Nurses’ screening; AD8; Specialist’s evaluation	Screened positive -13.7%	98.8% of nurses considered AD8 easy to use. 78.3% of GPs considered AD8 useful
Thyrian⁵⁰ 2016, Germany	516 80 59.5% Female	Dementia MCI	GP’s evaluation; ICD-10	MCI-90.8% Dementia-99.8%	Older adults from primary health care are considerably underdiagnosed
Koekkoek⁵¹ 2015, Netherlands	513 >70	MCI	GP’s evaluation; DSM-IV (Dementia); Winblad et al. (MCI)	15.2%	This study protocol describes all the procedures for the Cog-ld study
Chan⁵² 2016, Singapore	309 71.7 (±8.2) 60.5% Female	Dementia	DSM-IV; CDR	36.5%	For participant age, AD8 was better than MMSE and as good as MoCA
Koekkoek⁵³ 2016, Netherlands	228 76.8 60% Male	MCI	DSM-IV (Dementia); Winblad et al. (MCI)	19.3%	TYM’s negative predictive value (NPV) was 81% and SAGE’s was 85%. GP’s evaluations had a similar NPV, however, the positive predictive value was higher
Dungen⁵⁴ 2015, Netherlands	647 79.8 (±7.1) 39.6% Male	Dementia MCI	DSM-IV (Dementia); Petersen at al. (MCI)	Dementia -14% MCI-31.5%	The authors did not find statistical relevance in the number of diagnoses between the groups before or after intervention
Groeneveld⁵⁵ 2018, Netherlands	120 77.0 (±4.5) 60% Male	Dementia MCI	DSM-IV (Dementia). MCI: not dementia, but not normal cognition; cognitive complaints; objective impairment in one or more cognitive domain; no functional impairment	Dementia-2.5% MCI-30%	The authors suggested that patients with type 2 diabetes should be screened for MCI and dementia.
Campbell⁵⁶ 2018, USA	350 71.2 (±5.1) 79.1 % Female	Dementia MCI	Multidisciplinary group evaluation	Dementia - 2% MCI-94.8%	The use of anticholinergic drugs increased the likelihood of conversion from normal to MCI. On the other hand, reversion from MCI to normal cognition was not observed.
Jessen⁵⁷ 2014, Germany	2,892 79.7 (±3.58) 64.8% Female	Dementia MCI SMI	CERAD’s verbal memory task (SMI, eMCI, and IMCI); DSM-IV, SIDAM (Dementia)	Ml - 36.6% eMCI - 8.6% MCI-12.3% DA-7.4%	The highest risk for developing dementia was in the late MCI group. In SMI and early MCI groups, those who had concerns about their memory impairment had a similar risk for developing dementia.
Wray⁵⁸ 2014, USA	5,333 80.7 97% Male	Dementia	Medical records	Not mentioned	B0MC+ patients were 5.12 times more likely to receive a dementia diagnosis, when comparing to BOMC- group.
Alonso⁵⁹ 2016, Spain	4,360>65	MCI	Mini-cog screening test, MMSE and Alzheimer’s Questionnaire	18.5%	Cognitive impairment is a common reason for appointments in primary health care.
Brodaty⁶⁰ 2016, Australia	1,717 81.05 (±4.12)	Dementia	Medical records, MMSE	7.3%	GPCOG’s sensitivity was 79% and specificity 92%.

[TFN02] MCI: Mild Cognitive Impairment; CIND-Cognitive impairment not-dementia; SMI -Subjective Memory Impairment; eMCI: Early Mild Cognitive Impairment; lMCI: Late Mild Cognitive Impairment; GP: General Practitioner; ICD: International Statistical Classifi cations of Diseases and Related Health Problems; DSM: Diagnostic and Statistical Manual of Mental Disorders; MMSE- Mini-Mental State Examination; MoCA: Montreal Cognitive Assessment; CASI-S: Cognitive Abilities Screening Instrument-Short Form; EDQ: Early Dementia Questionnaire; SIDAM - Structured Interview for the diagnosis of Dementia of the Alzheimer type; CDR: Clinical Dementia Rating; GPCOG: General Practitioner assessment of Cognition.