About this Research Topic
Timely identification and management of dementia in primary care (PC) continues to be challenging. Unfortunately, many GPs have not incorporated available validated screening tools in everyday practice, mainly because dementia is considered a condition resulting from brain decay where there is very little to do and where drug treatment has limited effectiveness. Important issues in PC are: attitudes towards dementia diagnostic workup which varies from country to country (data from Low and Middle Income Countries are limited); inadequate knowledge and confidence in the topic; and practical issues (such as time constraints).
Depending on local protocols, Family Physician’s (FP)/General Practitioner’s (GP) involvement in the dementia diagnostic workup varies a lot and this is another line of research. In many countries FPs’ role is limited and this is particularly the case in countries where a specific pre-authorisation by a secondary care specialist is required in order to have the dementia medication reimbursed by the local health care system. Other relevant aspects are cultural prevailing beliefs about mental illness, the scarcity of dementia tools scientifically validated in this setting, the low educational level of the population, the paucity of specialized physicians on this topic and the exiguity of coordinated and integrated health care system.
The high prevalence of comorbidities in people with dementia, especially cardiovascular diseases and depression is another challenging aspect; in some cases, depression masks for years an underlining cognitive impairment. Living alone increases the risk of developing dementia by 50%, while participation in physical leisure activities may reduce the risk of dementia in subjects with Mild Cognitive Impairment (MCI). It is important to investigate how multimorbidity and dementia prevention are dealt with in PC.
Teams and integrated approaches in the community have proved to be quite effective and, understanding what the patient and family need at each stage along the dementia illness journey, is essential. It would be interesting to see how these aspects are addressed in different countries and if any innovative approaches have been proposed.
Most patients with dementia develop some type of neuropsychiatric symptoms, with a lower quality of life, high caregiver burden, psychotropic drug use and a major risk of institutionalisation. Important to see if PC physicians tend to address these important issues on their own or if they refer these patients to secondary care specialists.
The present Research Topic is aimed at widening our understanding of the challenging issues that dementia present in primary care in order to improve the clinical and public health approaches to this serious condition. Authors are invited to contribute to this collection with original research, review articles, opinions, and perspectives which originate from their specific interest in dementia in primary care. As part of the topics mentioned above, this Research Topic welcomes contributions using different research methods on the following lines of research: early diagnosis, training of GPS and other personnel involved in dementia care, dementia service development, caregiver burden, intermediate care, integrated care, dementia drug therapy and polypharmacy, social prescribing and community social services, geriatric rehabilitation and advanced care planning.
Keywords: Dementia, mild cognitive impairment, multimorbidity, aging, dementia early diagnosis, dementia diagnostic tools, integrated care, intermediate care
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