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P1‐258: CSF PROFILE ACCORDING TO A/T/N CLASSIFICATION IN A COHORT OF MCI PATIENTS
Author(s) -
Salvadori Nicola,
Farotti Lucia,
Eusebi Paolo,
Parnetti Lucilla
Publication year - 2018
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2018.06.264
Subject(s) - cerebrospinal fluid , tauopathy , neurodegeneration , medicine , pathophysiology , etiology , gastroenterology , cognitive impairment , lumbar puncture , neuropsychology , amyloidosis , pathology , disease , cognition , psychiatry
Background: The development of novel diagnostic tests for (Alzheimer’s) dementia has increased the number of available diagnostic options. This study examined patient-clinician communication as observed during clinical encounters prior to diagnostic testing, involving information provision and decisions about diagnostic testing. Methods:We performed an observational study in the routine diagnostic workup of dementia. In an unselected sample of 125 new patients from eight Dutch memory clinics, we audiotaped the encounters with their clinicians (N1⁄436) prior to diagnostic testing. A study-specific coding scheme was used to code the audiotaped encounters and categorize communication behavior (e.g., ‘Statements are made in which diagnostic testing or tests are explained/discussed: YES/NO’ ). In addition, the OPTION12-scale was used to assess the extent to which the clinicians involved patients in decision making regarding testing (range1⁄4 0 [no involvement] to 100 [high involvement]). Results: In 112/125 encounters, patients (mean age1⁄470, SD1⁄410; mean MMSE-score1⁄425, SD1⁄45) were accompanied by a caregiver. Mean duration of the pre-diagnostic testing encounter was 48 minutes (range 10-101). A reason for the encounter was voiced in 23/125 (18%) of the encounters, but never related to diagnostic testing. Most often the reason was ‘talking about complaints’ (21/ 125). In 74/125 (59%) encounters, testing was addressed to some extent. Clinicians’ behavior to involve patients in decision making regarding testing was low (mean OPTION-score1⁄416.6, SD1⁄412.8). If a decision was made during the encounter (70/125), diagnostic testing was often presented by the clinician as the obvious next step (e.g., “I am proposing...”), and/or the decision related to testing in general (yes/no), rather than to decisions about specific tests. Conclusions:Results suggest that informing patients on (the available options for) diagnostic testing for (Alzheimer’s) dementia is not routine in pre-diagnostic conversations. The decision to proceed diagnostic testing (or not) often seemed made prior to the encounter, potentially by the GP or fixed care path. If a decision was made during the encounter, this decision was often implicit, not related to specific tests, and with low levels of patient involvement. More research is needed to explore ways to improve patient involvement and assess their values and preferences related to diagnostic testing.