Perceptions of dementia: an exploratory study of the first signs noted by carers and primary care practitioners

Dementia is a complex syndrome that poses challenges for the person with dementia, their family, and health and social care professionals. Primary care is often the first point of contact for people with dementia (Briggs & Askham, 1999), and primary care practitioners are recognised as having an integral role to play in the diagnosis and management of dementia (Downs, 1996). Around 70 per cent of people with dementia living in the community live with their carer. Most informal carers are the spouse or daughter of the person with dementia (Alzheimer's Scotland, 2000). Previous research has shown that caring for people with dementia can be stressful, although it also has many positive aspects, and that carers need support systems in place for themselves and their relative.The aim of the current study was to explore the first reported signs of dementia by two groups known to be closely involved with individuals within the earlier stages of the condition, carers and primary care practitioners. Previously unanalysed data collected from carers and practitioners who participated in the Downs et al (2003) study "Improving the response of primary care practitioners to people with dementia and their families: A randomised controlled trial of educational interventions" was used.A grounded theory approach (Strauss & Corbin, 1990) was adopted to explore the first signs of dementia reported by 122 carers and 204 primary care practitioners. Five main categories and thirty-two subcategories related to cognitive, emotional, behavioural, physical and other (non-categorised) signs of dementia were generated. Statistical analysis was carried out to explore the effect of sociodemographic and occupational variables on the first signs of dementia reported by carers and practitioners, and the effect oftraining on practitioner signs reported.Findings were discussed and implications for clinical practice and future research considered

Methodological problems in dementia research in primary care: a case study of a randomized controlled trial

The emerging UK national research network in neurodegenerative diseases and dementias aims to promote large-scale community-based studies of therapeutic interventions, based in primary care. However, trials in primary care settings can be problematic, a common difficulty being the recruitment of a large enough sample. The article discusses recruitment issues in a multi-centre randomized controlled trial of differing educational approaches to improving dementia care in general practice. Sample size calculations based on community studies of prevalence may be misleading in intervention trials which may recruit practices with atypical demography. Recruitment rates for practitioners in this study were lower than expected. Professionals excluded themselves from the study mainly due to pressures of time and staff shortages, and we detected both ambivalent attitudes to primary care research and a perception that research into dementia care was not a high priority. Evaluation of the quality of care may be perceived as criticism of clinical practice, at a time when general practice is undergoing major administrative and contractual changes. Variations in Research Ethics Committee conditions for approval led to different methods of recruitment of patients and carers into the study, a factor which may have contributed to disparate levels of recruitment across study sites. Patient and carer levels of recruitment were lower than expected and were affected partly by carers' time pressures and other family commitments, but largely by problems in identifying patients and carers in the practices. The development of research potential in primary care is at an early stage and studies reliant on patient recruitment in general practice must allow for multiple obstacles to enrollment. This is particularly relevant for studies of dementia care, where the prevalence of dementia in a demographically average population is low and the incidence very low, compared with other disabilities. Professionals may give dementia low priority in allocating practice time for research projects, and strategies to address this problem are needed

Synthesis and structure-activity relationships of a novel series of pyrimidines as potent inhibitors of TBK1/IKKε kinases.

The design, synthesis and structure-activity relationships of a novel series of 2,4-diamino-5-cyclopropyl pyrimidines is described. Starting from BX795, originally reported to be a potent inhibitor of PDK1, we have developed compounds with improved selectivity and drug-like properties. These compounds have been evaluated in a range of cellular and in vivo assays, enabling us to probe the putative role of the TBK1/IKKε pathway in inflammatory diseases

Concordance with clinical practice guidelines for dementia in general practice

Background: Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care.  Aim: To determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia.  Design: Unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK.  Methods: Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated.  Results: We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing.  Discussion: The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records