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Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors
Bradford A, Kunik ME, Schulz P, Williams SP, Singh H.. Alzheimer disease and associated disorders, 2009-10-01
Topic: Risk, prevention and care in population studies
Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion on the basis of patient symptoms or caregivers' concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient, caregiver, provider, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.
Key findings
- Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact.
Why it matters
This 2009 systematic review of primary-care studies concluded that "the true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high," and that how often providers recognised dementia varied between studies, partly depending on dementia severity, degree of impairment, dementia subtype and how often the patient saw the provider. The main contributing factors it identified were problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. Rather than recommending screening, the authors advised that "until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis"; the review concerns detection only and reports no treatment, cure or prevention.
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Study details
- Study designsystematic review
- Evidence strengthHigh
How this study scored 67/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for sample size, effect reported and studied in people because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer disease and associated disorders) |
| Journal's citation record | 1 / 4 | Alzheimer Disease & Associated Disorders: journal h-index 131 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2009 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 6 / 7 | Cited 970 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 51.1 citations a year over 19 year(s) since 2009 |
| Impact for its field and year | 4 / 6 | Cited 10.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 63 other studies in this library |
| Still being cited | 4 / 4 | Cited 274 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Hardeep Singh: h-index 75 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Baylor College of Medicine: institution h-index 1,607 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 19568149) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 67 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1097/wad.0b013e3181a6bebc
- PubMed: 19568149
- Original source →
- Free full text: PubMed Central →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Bradford, A., Kunik, M. E., Schulz, P., Williams, S. P., & Singh, H. (2009). Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer disease and associated disorders. https://doi.org/10.1097/wad.0b013e3181a6bebc
Vancouver
Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer disease and associated disorders. 2009. doi:10.1097/wad.0b013e3181a6bebc. PMID: 19568149.
BibTeX
@article{bradford2009-19568149,
author = {Bradford, A. and Kunik, M. E. and Schulz, P. and Williams, S. P. and Singh, H.},
title = {{Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors}},
journal = {Alzheimer disease and associated disorders},
year = {2009},
doi = {10.1097/wad.0b013e3181a6bebc},
pmid = {19568149},
url = {https://doi.org/10.1097/wad.0b013e3181a6bebc}
}
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