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

Ford, Elizabeth, Greenslade, Nicholas, Paudyal, Priya, Bremner, Stephen, Smith, Helen, Banerjee, Sube, Sadhwani, Shanu, Rooney, Philip, Oliver, Seb and Cassell, Jackie (2018) Predicting dementia from primary care records: a systematic review and meta-analysis. PLoS ONE. pp. 1-23. ISSN 1932-6203

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Abstract

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. Clinical entities 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 be explored in future studies.

Item Type: Article
Keywords: Dementia, Primary Care, Electronic Health Records, Meta-analysis, Predictive models
Schools and Departments: Brighton and Sussex Medical School > Primary Care and Public Health
School of Mathematical and Physical Sciences > Physics and Astronomy
Subjects: R Medicine > R Medicine (General) > R858 Computer applications to medicine. Medical informatics
Depositing User: Elizabeth Ford
Date Deposited: 28 Mar 2018 09:08
Last Modified: 06 Apr 2018 13:35
URI: http://sro.sussex.ac.uk/id/eprint/74679

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Project NameSussex Project NumberFunderFunder Ref
ASTRODEM: Using astrophysics to close the 'diagnosis gap' for dementia in UK general practice.G1895WELLCOME TRUST202133/Z/16/Z