CLINICAL QUESTION

How accurate is the clinical judgment of primary care physicians when diagnosing symptomatic patients with dementia and cognitive impairment?

EVIDENCE-BASED ANSWER

In patients who present with cognitive concerns, the clinical judgment of primary care physicians is sensitive, but not specific, when used to screen for any cognitive impairment. It is specific, but not sensitive, when diagnosing overt dementia.¹ Primary care physicians should not rely solely on clinical judgment when evaluating patients for dementia or cognitive impairment; however, clinical judgment may help inform the choice of additional testing to confirm or exclude the diagnoses of dementia and cognitive impairment. (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

Patients with cognitive concerns commonly visit their primary care physicians for an initial evaluation. The incidence of cognitive impairment increases with age and encompasses a spectrum ranging from mild cognitive impairment to dementia. Approximately 6.9 million people in the United States who are 65 years and older are living with dementia, and this number will increase as the population ages.² Making a diagnosis of dementia and cognitive impairment can be challenging because it requires taking an extensive history in multiple cognitive domains that affect social and occupational functions, plus a mental status evaluation using clinical assessment tools that are inherently flawed. A neuropsychological evaluation may be needed for some patients when the initial assessment is inconclusive. Primary care physicians may also use their clinical judgment to help determine whether someone has dementia or cognitive impairment. The authors of this review sought to determine whether the clinical judgment of primary care physicians is accurate in screening for or diagnosing cognitive impairment and dementia in patients with cognitive concerns.