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Dementia
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General practice-based intervention for suspecting and detecting dementia in France

A cluster randomized controlled trial1

Virginie Rondeau

UniversitéVictor Segalen Bordeaux 2, France, Virginie.Rondeau{at}isped.u-bordeaux2.fr

Hervé Allain

University of Rennes, France

Serge Bakchine

Centre Hospitalier Universitaire, Reims, France, sbakchine{at}chu-reims.fr

Philippe Bonet

UNAFORMEC, France, p-bonet{at}cyber-sante.org

Frédérique Brudon

Clinique du Tonkin, France, frederique.brudon{at}clinique-tonkin.fr

Guy Chauplannaz

Clinique Charcot, France, guy.chauplannaz{at}wanadoo.fr

Bruno Dubois

Hôpital Pitié-Salpêtrière, France, bruno.dubois{at}psl.aphp.fr

Thierry Gallarda

Hôpital Sainte-Anne, France, t.gallarda{at}ch-sainte-anne.fr

Jean-Pierre Lepine

Hôpital Fernand Widal, France, jean-pierre.lepine{at}lrb.ap-hop-paris.fr

Florence Pasquier

Centre Hospitalier Régional Universitaire de Lille, France, pasquier{at}chru-lille.fr

Denis Pouchain

Cabinet Médical, France, dpouchain{at}wanadoo.fr

Karen Ritchie

INSERM, France, ritchie{at}montp.inserm.fr

Philippe Robert

Hôpital Pasteur, France, philippe.robert15{at}wanadoo.fr

Jacques Touchon

Centre Hospitalier Universitaire Gui de Chauliac, France, j-touchon{at}chu-montpellier.fr

Bruno Vellas

Centre Hospitalier Universitaire Casselardit, France, vellas.b{at}chu-toulouse.fr

Martine Vercelletto

Centre Hospitalier Universitaire, Nantes, France, mvercelletto{at}chu-nantes.fr

Marc Verny

Hôpital Pitié-Salpêtrière, France, marc.verny{at}psl.aphp.fr

Laure Carcaillon

INSERM,France, carcaillon{at}vjf.inserm.fr

Françoise Duveau

Laboratoire Eisai, France, Francoise_Duveau{at}eisai.net

Véronique Millet

Pfizer,France, veronique.millet{at}pfizer.com

Isabelle Tonelli

Laboratoire Eisai, France, Isabelle_Tonelli{at}eisai.net

Stéphane Schuck

Kappa Santé, France, stephane.schuck{at}kappasante.com

Jean-François Dartigues

UniversitéVictor Segalen Bordeaux 2, France, Jean-Francois.Dartigues{at}isped.u-bordeaux2.fr

The study evaluated the impact of a general practice-based intervention on 3021 patients in France aged 75 years and above with spontaneous memory complaints. The objective was to identify evocative signs of Alzheimer's disease through a cluster randomized controlled trial. The study involved 681 general practitioners (GPs), randomly selected and assigned to an intervention (n = 352) or a control group (n = 329), and 214 specialists. The intervention group participated in training sessions relating to dementia diagnosis and the use of brief neuropsychological tests suited to general practice. The control group dispensed usual general practitioner care. The primary outcome was suspicion of dementia by GPs. The secondary outcome was accurate detection of dementia by the GPs. Most patients (96%) were already followed by the GPs (mean follow-up duration 10.8 years, similar in both groups). Suspicion of dementia was two-fold higher for GPs in the intervention group (adjusted OR = 1.99, p < 0.0001). Probability of suspected dementia increased with patient age and decreased with educational level. However the positive predictive value was not significantly different between the two groups (60.9% vs. 64.4%, p = 0.41). GPs from the intervention group also had a higher probability (adjusted OR = 2.24, p = 0.01) of correctly detecting demented patients (intervention did not increase the number of diagnosed cases of dementia, but increased the number of suspected cases that were later confirmed by specialists). The study showed that information on dementia and application of simple psychometric tests could improve the precision of a GP's diagnosis without changing the efficacy of detection of dementia.

Key Words: Alzheimer's disease • diagnosis • general practice • psychometric tests • training sessions • trial

Dementia, Vol. 7, No. 4, 433-450 (2008)
DOI: 10.1177/1471301208096628
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