Effect of neurological screening on early dementia detection in southern Italy

Abstract

Objective: Population screening can facilitate early diagnosis of dementia and improve disease management. This study examined the effects of a screening campaign for neurodegenerative disorders on the early diagnosis of dementia using 2-year follow-up data.

Methods: A 5-day screening campaign was conducted that comprised neurological, neuropsychological and other specialist examinations. Identification of alterations during the neurological examination was followed-up by further diagnostic examinations to confirm the neurological impairment.

Results: Neurological alterations were observed in 39% of the screened subjects, who were mostly diagnosed with mild cognitive impairment and referred to a dementia and cognitive disorders centre. Suspicion of neurological impairment was a risk factor for inclusion in a specific neurological ambulatory follow-up and a condition for exemption from payment for medical examinations.

Conclusions: Neurodegenerative screening initiatives should include subjects selected by general practitioners. It would be useful to create a network including primary care physicians and cognitive disorder centres. Telemedicine tools (e.g., teleconsulting) could also be used to facilitate early diagnosis.

Keywords: Screening campaign; dementia; general practitioner; mild cognitive impairment; neurodegenerative disorders; neuroepidemiology; prevention; public health.

Figure 1.

Step-by-step description of the population screening procedure.

Figure 2.

Participant selection procedure for the whole screening process. ENT: ear, nose and throat evaluation; EEG: electroencephalogram; ECG: electrocardiogram; EP: evoked potential; CDU: carotid Doppler ultrasonography; MRI: magnetic resonance imaging; CT: computed tomography; PSG: polysomnography; Echo: echocardiogram.

Figure 3.

Examinations performed during the screening week. Red bars represent the proportion of subjects without neurological alteration; the blue bars represent the proportion of subjects with neurological alteration.

Figure 4.

Examinations performed at the specialist ambulatory care facilities during the follow-up phase. Red bars represent the proportion of subjects with subsequent inclusion in the ambulatory follow-up (true positive); the blue bars represent the proportion of subjects not included in the follow-up (false positive). Data for lost subjects were not included.