Predicting dementia from primary care records: A systematic review and meta-analysis

Introduction: Possible dementia is usually identified in primary care by general practitioners (GPs) who refer to specialists for diagnosis. Only two-thirds of dementia cases are currently recorded in primary care, so increasing the proportion of cases diagnosed is a strategic priority for the UK an...

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Main Authors: Ford, Elizabeth, Greenslade, Nicholas, Paudyal, Priya, Bremner, Stephen, Smith, Helen Elizabeth, Banerjee, Sube, Sadhwani, Shanu, Rooney, Philip, Oliver, Seb, Cassell, Jackie
Other Authors: Forloni, Gianluigi
Format: Article
Language:English
Published: 2018
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Online Access:https://hdl.handle.net/10356/89308
http://hdl.handle.net/10220/44872
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Institution: Nanyang Technological University
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spelling sg-ntu-dr.10356-893082020-11-01T05:21:24Z Predicting dementia from primary care records: A systematic review and meta-analysis Ford, Elizabeth Greenslade, Nicholas Paudyal, Priya Bremner, Stephen Smith, Helen Elizabeth Banerjee, Sube Sadhwani, Shanu Rooney, Philip Oliver, Seb Cassell, Jackie Forloni, Gianluigi Lee Kong Chian School of Medicine (LKCMedicine) Dementia Risk Prediction Tool Introduction: Possible dementia is usually identified in primary care by general practitioners (GPs) who refer to specialists for diagnosis. Only two-thirds of dementia cases are currently recorded in primary care, so increasing the proportion of cases diagnosed is a strategic priority for the UK and internationally. Variables in the primary care record may indicate risk of developing dementia, and could be combined in a predictive model to help find patients who are missing a diagnosis. We conducted a meta-analysis to identify clinical entities with potential for use in such a predictive model for dementia in primary care. Methods and findings: We conducted a systematic search in PubMed, Web of Science and primary care database bibliographies. We included cohort or case-control studies which used routinely collected primary care data, to measure the association between any clinical entity and dementia. Meta-analyses were performed to pool odds ratios. A sensitivity analysis assessed the impact of non-independence of cases between studies. From a sift of 3836 papers, 20 studies, all European, were eligible for inclusion, comprising >1 million patients. 75 clinical entities were assessed as risk factors for all cause dementia, Alzheimer’s (AD) and Vascular dementia (VaD). Data included were unexpectedly heterogeneous, and assumptions were made about definitions of clinical entities and timing as these were not all well described. Meta-analysis showed that neuropsychiatric symptoms including depression, anxiety, and seizures, cognitive symptoms, and history of stroke, were positively associated with dementia. Cardiovascular risk factors such as hypertension, heart disease, dyslipidaemia and diabetes were positively associated with VaD and negatively with AD. Sensitivity analyses showed similar results. Conclusions: These findings are of potential value in guiding feature selection for a risk prediction tool for dementia in primary care. Limitations include findings being UK-focussed. Further predictive entities ascertainable from primary care data, such as changes in consulting patterns, were absent from the literature and should also be explored in future studies. Published version 2018-05-23T04:44:33Z 2019-12-06T17:22:32Z 2018-05-23T04:44:33Z 2019-12-06T17:22:32Z 2018 Journal Article Ford, E., Greenslade, N., Paudyal, P., Bremner, S., Smith, H. E., Banerjee, S., et al. (2018). Predicting dementia from primary care records: A systematic review and meta-analysis. PLOS ONE, 13(3), e0194735-. https://hdl.handle.net/10356/89308 http://hdl.handle.net/10220/44872 10.1371/journal.pone.0194735 en PLOS ONE © 2018 Ford et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 23 p. application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Dementia
Risk Prediction Tool
spellingShingle Dementia
Risk Prediction Tool
Ford, Elizabeth
Greenslade, Nicholas
Paudyal, Priya
Bremner, Stephen
Smith, Helen Elizabeth
Banerjee, Sube
Sadhwani, Shanu
Rooney, Philip
Oliver, Seb
Cassell, Jackie
Predicting dementia from primary care records: A systematic review and meta-analysis
description Introduction: Possible dementia is usually identified in primary care by general practitioners (GPs) who refer to specialists for diagnosis. Only two-thirds of dementia cases are currently recorded in primary care, so increasing the proportion of cases diagnosed is a strategic priority for the UK and internationally. Variables in the primary care record may indicate risk of developing dementia, and could be combined in a predictive model to help find patients who are missing a diagnosis. We conducted a meta-analysis to identify clinical entities with potential for use in such a predictive model for dementia in primary care. Methods and findings: We conducted a systematic search in PubMed, Web of Science and primary care database bibliographies. We included cohort or case-control studies which used routinely collected primary care data, to measure the association between any clinical entity and dementia. Meta-analyses were performed to pool odds ratios. A sensitivity analysis assessed the impact of non-independence of cases between studies. From a sift of 3836 papers, 20 studies, all European, were eligible for inclusion, comprising >1 million patients. 75 clinical entities were assessed as risk factors for all cause dementia, Alzheimer’s (AD) and Vascular dementia (VaD). Data included were unexpectedly heterogeneous, and assumptions were made about definitions of clinical entities and timing as these were not all well described. Meta-analysis showed that neuropsychiatric symptoms including depression, anxiety, and seizures, cognitive symptoms, and history of stroke, were positively associated with dementia. Cardiovascular risk factors such as hypertension, heart disease, dyslipidaemia and diabetes were positively associated with VaD and negatively with AD. Sensitivity analyses showed similar results. Conclusions: These findings are of potential value in guiding feature selection for a risk prediction tool for dementia in primary care. Limitations include findings being UK-focussed. Further predictive entities ascertainable from primary care data, such as changes in consulting patterns, were absent from the literature and should also be explored in future studies.
author2 Forloni, Gianluigi
author_facet Forloni, Gianluigi
Ford, Elizabeth
Greenslade, Nicholas
Paudyal, Priya
Bremner, Stephen
Smith, Helen Elizabeth
Banerjee, Sube
Sadhwani, Shanu
Rooney, Philip
Oliver, Seb
Cassell, Jackie
format Article
author Ford, Elizabeth
Greenslade, Nicholas
Paudyal, Priya
Bremner, Stephen
Smith, Helen Elizabeth
Banerjee, Sube
Sadhwani, Shanu
Rooney, Philip
Oliver, Seb
Cassell, Jackie
author_sort Ford, Elizabeth
title Predicting dementia from primary care records: A systematic review and meta-analysis
title_short Predicting dementia from primary care records: A systematic review and meta-analysis
title_full Predicting dementia from primary care records: A systematic review and meta-analysis
title_fullStr Predicting dementia from primary care records: A systematic review and meta-analysis
title_full_unstemmed Predicting dementia from primary care records: A systematic review and meta-analysis
title_sort predicting dementia from primary care records: a systematic review and meta-analysis
publishDate 2018
url https://hdl.handle.net/10356/89308
http://hdl.handle.net/10220/44872
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