Age and ageing · 2026
How does diagnostic subtype affect the quality of primary care for people with dementia? A retrospective cohort study in 1490 English general practices.
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Morris Charlotte, Mok Pearl L H, Robinson Dame Louise, Ashcroft Darren M, Blakeman Tom, Kontopantelis Evangelos
Аннотация
INTRODUCTION: Diagnostic subtype has been suggested as a determinant of inequity for people with dementia; its impact on primary care provision is underexplored. This study investigated the association between dementia subtype and likelihood of receiving guideline-consistent primary care.
METHOD: Retrospective cohort study using Clinical Practice Research Datalink (Aurum) database, 1.1.2006-30.06.2024. We examined potential inequity with eight dementia subtypes: Alzheimer's disease (AD), Lewy body dementia (LBD), vascular, frontotemporal, unspecified, other and two mixed categories. Six outcomes were examined: care plan or medication review (both within 24 months of index) and four indicators of potentially inappropriate prescribing (PIP) (high anti-cholinergic burden drugs, z-drugs, benzodiazepines and anti-psychotics). Cox-regression models were used, adjusting for: age, sex, comorbidities, deprivation and ethnicity.
RESULTS: A total of 571 663 people were included and 72.1% received a care plan; 79.4% received a medication review within 24 months. Compared to AD: people with mixed dementias were more likely to receive a care plan [hazard ratio (HR) 1.29, 95% confidence interval (CI) 1.26-1.32 for mixed including AD/LBD, HR 1.37, 1.32-1.43 for mixed non-AD/LBD]. All other subtypes were less likely to receive a care plan. Individuals with mixed AD/LBD (HR 1.28, 1.26-1.32), mixed non-AD/LBD (HR 1.35, 1.26-1.45), vascular (HR 1.05, CI 1.04-1.07), LBD (HR 1.02, 1.01-1.04) and unspecified (HR 1.02, 1.01-1.03) were more likely to receive medication reviews. Compared to AD, all other subtypes were more likely to experience PIP across all four indicators.
CONCLUSION: We found greater likelihood of PIP in people with non-AD dementias, a novel finding. Further research is needed, especially with new AD drugs potentially widening disparities.
METHOD: Retrospective cohort study using Clinical Practice Research Datalink (Aurum) database, 1.1.2006-30.06.2024. We examined potential inequity with eight dementia subtypes: Alzheimer's disease (AD), Lewy body dementia (LBD), vascular, frontotemporal, unspecified, other and two mixed categories. Six outcomes were examined: care plan or medication review (both within 24 months of index) and four indicators of potentially inappropriate prescribing (PIP) (high anti-cholinergic burden drugs, z-drugs, benzodiazepines and anti-psychotics). Cox-regression models were used, adjusting for: age, sex, comorbidities, deprivation and ethnicity.
RESULTS: A total of 571 663 people were included and 72.1% received a care plan; 79.4% received a medication review within 24 months. Compared to AD: people with mixed dementias were more likely to receive a care plan [hazard ratio (HR) 1.29, 95% confidence interval (CI) 1.26-1.32 for mixed including AD/LBD, HR 1.37, 1.32-1.43 for mixed non-AD/LBD]. All other subtypes were less likely to receive a care plan. Individuals with mixed AD/LBD (HR 1.28, 1.26-1.32), mixed non-AD/LBD (HR 1.35, 1.26-1.45), vascular (HR 1.05, CI 1.04-1.07), LBD (HR 1.02, 1.01-1.04) and unspecified (HR 1.02, 1.01-1.03) were more likely to receive medication reviews. Compared to AD, all other subtypes were more likely to experience PIP across all four indicators.
CONCLUSION: We found greater likelihood of PIP in people with non-AD dementias, a novel finding. Further research is needed, especially with new AD drugs potentially widening disparities.