Affiliations: [a] INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France | [b] University of Bordeaux, Bordeaux, France | [c] Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden | [d] INSERM U1061, Neuropsychiatrie: Recherche Epidémiologique et Clinique, Université de Montpellier, Montpellier, France | [e] Service de Neurologie, Department of Clinical Neurosciences, CHU Pellegrin, Bordeaux, France | [f] INSERM, Clinical Investigation Center – Clinical Epidemiology 7, Bordeaux, France
Correspondence:
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Correspondence to: Clément Pimouguet, Institut de Santé Publique, d’Epidémiologie et de Développement, Université Victor Segalen Bordeaux 2, 146 rue Leo Saignat, 33076 Bordeaux Cedex, France. Tel.: +33 05 57 57 56 44; Fax: +33 05 56 24 00 81; E-mail: clement.pimouguet@isped.u-bordeaux2.fr
Abstract: Background:Although early diagnosis has been hypothesized to benefit both patients and caregivers, until now studies evaluating the effect of early dementia diagnosis are lacking. Objective:To investigate the influence of early specialist referral for dementia on the risk of institutionalization and functional decline in Activity of Daily Living (ADL). Methods:Incident dementia cases were screened in a prospective population-based cohort, the Three-City Study, and initial specialist consultation for cognitive complaint was assessed at dementia diagnosis. Proportional hazard regression and illness-death models were used to test the association between specialist referral and, respectively, institutionalization and functional decline. Results:Only one third of the incident individuals with dementia had consulted a specialist for cognitive problems early (36%). After adjustment on potential confounders (including cognitive and functional decline) and competing risk of death, participants who had consulted a specialist early in the disease course presented a higher rate of being institutionalized than those who did not (Hazard Ratio = 2.00, 95% Confidence Interval (CI): 1.09– 3.64). But early specialist referral was not associated with further functional decline (HR = 1.09, 95% CI: 0.71– 1.67). Conclusions:Early specialist referral in dementia is associated with increased risk of institutionalization but not with functional decline in ADL. These findings suggest that early care referral in dementia may be a marker of concern for patients and/or caregivers; subsequent medical and social care could be suboptimal or inappropriate to allow patients to stay longer at home.
Keywords: Dementia, dependency, institutionalization, population-based study, secondary care
