Dementia Undiagnosed in Poor Older Adults with Functional Impairment

Objectives: To identify variables associated with diagnosing dementia in poor older adults by comparing older people with dementia who were diagnosed by their primary care physicians (PCPs) with those not diagnosed by their PCP.

Design: Observational study.

Setting: Community-based, in-home cognitive assessment program.

Participants: Four hundred eleven adults aged 55 and older with cognitive impairment.

Measurements: Instrumental activities of daily living (IADLs), activities of daily living (ADLs), Mini-Mental State Examination, Short Blessed Memory Orientation and Concentration Test, and Clinical Dementia Rating.

Results: Alzheimer's disease was the most common diagnosis in this group of primarily African-American (73%) older people. Of the 411 participants, 232 (56%) were not diagnosed by their PCP. Participants without a previous diagnosis were older (mean age 81.7 vs 78.7, P=.01), more independent in IADLs (P<.001), and more likely to live alone (P=.001) than persons diagnosed by their PCP. Of the 201 who lived alone, 66% were not diagnosed with dementia by their PCP. Variables associated with PCP diagnosis were more severe cognitive impairment (P<.001), spouse caregiver (P=.009), younger age (P=.02) and care from a university-based PCP (P=.04).

Conclusion: Persons with dementia who were older and lived alone were less likely to be diagnosed by their PCP. Although persons not diagnosed by their PCP had less cognitive impairment, they had substantial impairment in activities, including handling finances, cooking, and managing medications.