Comparing dementia diagnostics in primary care and in memory clinics: which makes older patients fare better in the long term?

INTERVENTION: Intervention: For the primary care arm, the diagnostic procedures are described in the Dementia Guideline of the Dutch College of General Practitioners. The minimum diagnostic work‐up includes: history taking with the patient (and caregiver if available), cognitive screening (MMSE and clock drawing test) and assessment of daily functioning. Additional diagnostics may be performed at the discretion of the GP and may include blood tests, practice nurse consultation, consultation with an elderly care physician (ECP), as available in the practice or regional settings. The diagnostic criteria according to McKahn are used. Participating GPs are offered a short training on dementia diagnostics in primary care, to refresh their knowledge of the primary care guidelines (NHG standard). All will receive a summary of the GP guideline in a flowchart format and an overview of local diagnostic services and collaboration agreements. All are in line with current guidelines and without additional diagnostic procedures. The training will be provided by a GP experienced with dementia diagnostics and a neurologist. Comparator: In the referral arm, the diagnostic procedures at the MC are completely at the discretion of the physician/multidisciplinary team and may include neuroimaging with CT/MRI, neuropsychological examination, cerebrospinal fluid (CSF) examination, electroencephalogram (EEG) and nuclear imaging. The use of diagnostic instruments, initial diagnosis and the time to diagnosis are collected in both arms. All professionals provide care as usual over the long‐term follow‐up. Randomization: Participants will be randomly assigned to further diagnostic CONDITION: Persons aged 70 years and older with memory complaints ; Mental and Behavioural Disorders PRIMARY OUTCOME: Daily functioning measured using the Amsterdam Instrumental Activities of Daily Living Questionnaire (A‐iADL‐Q). Both primary and secondary outcomes are measured at baseline, 6 months, 18 months and 30 months (four time points including baseline) or until attrition due to death, because the relatively short diagnostic trajectories are likely to have long‐term consequences due to disease management decisions following diagnosis. In case of institutionalization, primary outcome assessment continues, other outcomes if feasible and appropriate. INCLUSION CRITERIA: All patients 70 years and older consulting the GP with memory problems are eligible if the patient and GP consider starting diagnostic evaluation SECONDARY OUTCOME: ; 1. Diagnostic accuracy, measured using the first dementia diagnosis as the inde Xdiagnosis and the diagnosis at 30 months as the reference standard. Dementia diagnosis will be assessed using an algorithmic approach, with all clinical information available in electronic medical records.; 2. Time to dementia diagnosis assessed based on information available in electronic medical records; 3. Acute admissions and time to institutionalization (months): information available in electronic medical records; 4. (Time to) mortality reported by caregiver or general practitioner; 5. Quality of life measured using EQ‐5D; 6. Costs measured using Resource Utilization in Dementia (RUD); 7. Cognition measured using the short cognitive screening test Mini‐Mental State Examination (MMSE); 8. Behavior measured using the Neuro‐Psychiatric Inventory Questionnaire (NPI‐Q); 9. Mood measured using the Geriatric Depression Scale (GDS‐15); 10. Caregiver burden measured using perseverance time; ; Both primary and secondary outcomes are measured at baseline, 6 months, 18 months and 30 months (four time points including baseline) or until attrition due to death, because the relatively short diagnostic trajectories are likely to have long‐term consequences due to disease management decisions following diagnosis. In case of institutionalization, primary outcome assessment continues, other outcomes if feasible and appropriate.;