Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care:: ISSEA study

Objective. To describe the initial treatment of patients > 60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. Design. Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. Setting. A total of 105 primary care centres. Participants. The study included 921 patients who attended a clinic. Main measurements. In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. Results. The majority of subjects were female (66.9%) and the mean age was 74.-3 +/- 6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), actiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. Conclusions. The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective.