@article{8b4dcb50f9b54b87a2a1b30ceea5d0b2,
title = "Prevalence of dementia diagnoses not otherwise specified in eight European countries: a cross-sectional cohort study",
abstract = "BackgroundDementia is a syndrome, with a wide range of symptoms. It is important to have a timely diagnosis during the disease course to reduce the risk of medication errors, enable future care planning for the patient and their relatives thereby optimizing quality of life (QoL). For this reason, it is important to avoid a diagnosis of dementia not otherwise specified (DNOS) and instead obtain a diagnosis that reflects the underlying pathology. The aim of this study was to investigate the prevalence and associated factors of DNOS in persons with dementia living at home or in a nursing home.MethodsThis is a cross-sectional cohort study performed in eight European countries. Persons with dementia aged 65years living at home (n=1223) or in a nursing home (n=790) were included. Data were collected through personal interviews with questionnaires based on standardised instruments. Specific factors investigated were sociodemographic factors, cognitive function, and mental health, physical health, QoL, resource utilization and medication. Bivariate and backward stepwise multivariate regression analyses were performed.ResultsThe prevalence of DNOS in the eight participating European countries was 16% (range 1-30%) in persons living at home and 21% (range 1-43%) in persons living in a nursing home. These people are more often older compared to those with a specific dementia diagnosis. In both persons living at home and persons living in a nursing home, DNOS was associated with more severe neuropsychiatric symptoms and less use of anti-dementia medication. In addition, persons with DNOS living at home had more symptoms of depression and less use of antidepressant medication.ConclusionsThe prevalence of DNOS diagnosis is common and seems to vary between European countries. People with DNOS are more often older with more severe neuropsychiatric symptoms and receive fewer anti-dementia medication, anxiolytics and antidepressants. This would support the suggestion that a proper and specific diagnosis of dementia could help the management of their disease.",
keywords = "Dementia, Diagnosis, Geriatrics, Home care, Nursing homes, Ordinary housing, Neurocognitive disorders, Regression analysis, CARE, DEPRESSION, SYMPTOMS, MORTALITY, DISEASE, PEOPLE",
author = "Connie Lethin and Hallberg, {Ingalill Rahm} and Guiteras, {Anna Renom} and Hilde Verbeek and Kai Saks and Minna Stolt and Adelaida Zabalegui and Maria Soto-Martin and Christer Nilsson",
note = "Funding Information: This study was supported by grants from the Greta and Johan Kocks Foundation and Sk{\aa}ne University Hospitals Foundations in Sweden. The RTPC study was supported by a grant from the European Commission within the 7th Framework Programme (contract number 242153). Funding Information: This study was a cross-sectional cohort study performed 2010–2013 in eight European countries within the European project RightTimePlaceCare (RTPC) (funded under the EU 7th Framework Programme for Research, contract number 24 21 53). Participating countries were Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the United Kingdom [25]. The eight countries have different welfare systems and health care and social service system with regard to the responsibility for the family. In continental Europe, the role of the family is most important, in the Nordic countries, the state has a central role and in the Anglo-Saxon countries commercial caregivers predominate. In this study, screening for dementia (not available in Estonia) was mainly performed by GPs and in some countries also by registered nurses (Finland, Spain and the United Kingdom). Professionals in this study involved in the procedures to establish the diagnosis, pharmacological treatment for dementia and pharmacological treatment for BPSD were GPs and in some cases medical specialists in neurology, psychiatry or geriatrics [26]. The study population consisted of 2013 persons with dementia, 1223 living at home and 790 living in a nursing home in both rural and urban areas. Inclusion criteria were age ≥ 65 years, having a primary dementia diagnosis, having a Standardized Mini-Mental State Examination (SMMSE) score ≤ 24 [27], and living at home with support from formal health care and social services and at risk of moving to a nursing home within 6 months, or living in a nursing home. The diagnoses of people with dementia were established in outpatient care by GPs or specialist physicians (neurologists, geriatricians, psychiatrists) or in specialized memory clinics. Recruitment of participants was through a contact person in each country and the same procedure as described previously [25] was followed. Participants were recruited in outpatient care and nursing homes, and in inpatient care in hospitals and psychogeriatric clinics. Data were collected through personal interviews with questionnaires based on standardised instruments outlined below. Demographic data collected for this study was age and gender of the person with dementia, as well as duration of symptoms in years and dementia diagnosis. Factors related to DNOS included cognition, comorbidity, QoL, ADLs, depression, resource utilization and behavioural problems. Furthermore, to investigate pharmacological treatment, information using Anatomical Therapeutic Chemical Classification code was collected regarding the use of psychotropics and antipsychotics (ATC N05A), anxiolytic (ATC N05B), sedatives (ATC N05C), antidepressants (ATC N06A) and anti-dementia medication (ATC N06D). Publisher Copyright: {\textcopyright} 2019 The Author(s).",
year = "2019",
month = jun,
day = "24",
doi = "10.1186/s12877-019-1174-3",
language = "English",
volume = "19",
journal = "BMC Geriatrics",
issn = "1471-2318",
publisher = "BioMed Central Ltd",
}