67 * CASE-FINDING FOR DEMENTIA: WHO ARE THE UNDIAGNOSED?

Abstract

Introduction: Delays in diagnosing dementia could lead to suboptimal care. Any policy of active case finding for dementia needs to be informed by an understanding of the population with undiagnosed dementia. We used data from a population representative sample of people with dementia aged 70 years and older in the United States to characterise the undiagnosed population and identify factors associated with non-diagnosis. Methods: The Aging, Demographics and Memory (ADAMS) study Wave A includes 856 participants, sampled from participants of the 2000 and 2002 waves of the Health and Retirement Study. Participants were assigned a Clinical Dementia Rating (CDR) score following a detailed neuropsychiatric investigation and informant interview. Informants were also asked whether the participant had ever received a doctor's diagnosis of dementia. We used multiple logistic regression to identify clinical and socio-demographic factors independently associated with diagnosis among those with dementia defined by DSM-IV criteria. Results: Of those with dementia (n = 310), 77 (25%) were married and lived at home, 159 (51%) were unmarried but living at home, while 74 (25%) lived in a nursing home. A prior diagnosis of dementia was reported by 122 informants (weighted proportion = 36%). Diagnosis was associated with greater clinical dementia rating (CDR) score; ranging from 24% (CDR = 1) to 83% (CDR = 5). Those aged 90 or older (OR = 0.35; 95% CI = 0.14-0.90) were less likely to be diagnosed, but diagnosis was more common among married women (OR = 4.5; 95% CI: 1.4-15.0) and those exhibiting agitated or aggressive (OR = 2.3; 95% CI = 1.1-5.2) or aberrant behaviour (OR = 2.6; 95% CI = 1.1-6.5) after adjusting for all other factors. Conclusions: People with dementia who are undiagnosed are older, more likely to be unmarried, male, have less severe dementia and have fewer behavioural problems than those with a diagnosis. Case-finding in routine practice must guard against exacerbating potential inequality in access to early diagnosis. Acknowledgement: The ADAMS study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan.