Early presentations of dementia in a diverse population

Abstract

Introduction: Improved recognition of non-cognitive presentations of dementia could reduce inequalities in dementia diagnosis, particularly if sociocultural factors influence help-seeking for cognitive symptoms.

Methods: We conducted a nested case-control study using electronic healthcare records from primary care practices in East London, United Kingdom, to assess associations between prediagnostic presentations to primary care and subsequent dementia diagnosis.

Results: We included 4137 individuals with a dementia diagnosis and 15,754 controls in the matched analysis. In addition to memory difficulties, a range of symptoms were more common in the decade before diagnosis, including depression, anxiety, use of antipsychotics, insomnia, constipation, incontinence, hypotension, hearing loss, imbalance, and dizziness.

Discussion: A range of non-cognitive presentations are seen during the prodromal period of dementia in a diverse population. Improved recognition of these associations and their variation by ethnicity could increase access to dementia diagnosis through improved recognition of early features in people from different sociocultural backgrounds.

Highlights: Prediagnostic signs of dementia include cognitive and non-cognitive symptoms. Psychiatric symptoms are common up to a decade prior to a dementia diagnosis. Autonomic prediagnostic symptoms are more common among South Asian groups. The importance of prediagnostic symptoms of dementia varies by ethnicity.

Keywords: dementia; early diagnosis; primary care; prodromal.

FIGURE 1

Temporal trends in prediagnostic presentations of dementia. (Error bars are representative of the 95% confidence intervals). Legend: plots show odds of receiving dementia diagnosis within 0 to 2, 2 to 5, and 5 to 10 years after experiencing each prediagnostic symptom.