Use of cognitive screening instruments in primary care: the impact of national dementia directives (NICE/SCIE, National Dementia Strategy).

BACKGROUND Publication of national dementia directives, namely the National Institute for Health and Clinical Excellence/Social Care Institute for Excellence (NICE/SCIE) guidelines (2006) and the National Dementia Strategy (NDS; 2009), has aimed to improve dementia awareness, diagnosis and management in all sectors of the health service. AIM To measure the frequency of cognitive screening instrument use reported in referrals from primary care to a dedicated secondary care Cognitive Function Clinic (CFC) over the period encompassing the launch of NICE/SCIE guidance and NDS, in comparison with cohorts seen before these directives were issued. The design of study is prospective. The setting of the study is CFC, Regional Neuroscience Centre. METHOD Over a 2 year period (February 2008 to February 2010), referral letters for patients referred from primary care to CFC (n = 306) were examined for mention of cognitive screening instrument use. Patients were evaluated in CFC with standard clinical, neuropsychological and neuroimaging methods and diagnoses were made following widely accepted diagnostic criteria for dementia and dementia subtypes. RESULTS There was an increase in the number of GP referrals over the study period compared to a prior cohort but the proportion of dementia diagnoses fell and the frequency of cognitive screening instrument use was unchanged. CONCLUSIONS Increased numbers of referrals would be consistent with an awareness raising effect of NICE/SCIE and NDS and a willingness among GPs to refer cases. But the falling proportion of dementia diagnoses suggests that these are 'worried well' individuals. There is no evidence for closure of the dementia 'diagnosis gap'.