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Research

Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network

Neil Drummond, Richard Birtwhistle, Tyler Williamson, Shahriar Khan, Stephanie Garies and Frank Molnar
April 28, 2016 4 (2) E177-E184; DOI: https://doi.org/10.9778/cmajo.20150050
Neil Drummond
Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont.
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Richard Birtwhistle
Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont.
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Tyler Williamson
Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont.
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Shahriar Khan
Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont.
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Stephanie Garies
Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont.
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Frank Molnar
Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont.
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    Figure 1

    Age- and sex-standardized prevalance of dementia among community-dwelling patients aged 65 years and older, by year and province (for supporting data, see Appendix 1, available at www.cmajopen.ca/content/4/2/E177/suppl/DC1).

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    Table 1: Prevalence of dementia, by age and sex
    Age group, yrSex; % of patients (n/N) [95% CI]
    MaleFemale
    65-742.4 (336/13 964) [2.2-2.7]2.5 (426/16 914) [2.3-2.8]
    75-849.0 (745/8 243) [8.4-9.7]9.7 (1 067/10 978) [9.2-10.3]
    ≥ 8520.5 (648/3 158) [8.4-9.7]22.5 (1 330/5 920) [21.4-23.5]
    Total (observed)7.7 (4 552/59 177) [7.5-7.9]
    Total (age and sex standardized)7.3 [7.1-7.5]

    Note: CI = confidence interval.

      • View popup
      Table 2: Factors influencing the prevalence of dementia, adjusted for age and sex
      FactorNo. of patientsPrevalence ratio
      (95% CI)
      Residence location
      Urban42 9401.00 (ref)
      Rural14 4380.93 (0.87-1.00)
      Missing data1 7991.50 (1.36-1.67)
      Weight category (BMI)
      Normal (18-24)12 2461.00 (ref)
      Underweight (< 18)1 5521.13 (0.98-1.33)
      Overweight (25-29)14 5100.94 (0.87-1.03)
      Obese (≥ 30)12 8430.89 (0.81-0.97)
      Missing data18 0261.03 (0.96-1.11)
      Comorbidity
      Hypertension30 6910.97 (0.95-1.00)
      Diabetes13 1301.10 (1.04-1.16)
      Depression9 3552.40 (2.29-2.52)
      COPD6 7041.08 (1.00-1.17)
      Osteoarthritis17 0281.01 (0.97-1.06)
      Epilepsy5922.89 (2.32-3.60)
      Parkinsonism7942.93 (2.47-3.47)

      Note: BMI = body mass index, CI = confidence interval, COPD = chronic obstructive pulmonary disorder, ref = reference group.

        • View popup
        Table 3: Number and type of dementia medications prescribed by primary care providers to patients with dementia, by year and province Table 3: Number and type of dementia medications prescribed by primary care providers to patients with dementia, by year and province
        VariableYear; no. (%) of patients
        20082009201020112012
        Alberta
        No. of medications*
           0658 (94.8)632 (91.1)616 (88.6)616 (88.8)609 (87.8)
           133 (4.8)60 (8.7)77 (11.1)75 (10.8)85 (12.3)
           23 (0.4)2 (0.3)1 (0.1)3 (0.4)0
           3-4001 (0.1)00
        Type of medication†
           Donepezil21 (60.0)21 (65.6)28 (62.2)29 (72.5)57 (67.1)
           Galantamine13 (37.1)7 (21.9)17 (37.8)12 (30.0)24 (28.2)
           Memantine4 (11.4)2 (6.3)1 (2.2)1 (2.5)7 (8.2)
           Rivastigmine4 (11.4)4 (12.5)3 (6.7)7 (17.5)9 (10.6)
        Manitoba
        No. of medications*
           0466 (94.1)456 (92.1)446 (90.1)445 (89.9)445 (89.0)
           128 (5.7)38 (7.7)48 (9.7)49 (9.9)49 (9.9)
           21 (0.2)1 (0.2)1 (0.2)1 (0.2)1 (0.2)
           3-40001 (0.2)0
        Type of medication†
           Donepezil11 (91.7)11 (84.6)14 (82.4)17 (77.3)47 (94.0)
           Galantamine1 (8.3)4 (30.8)2 (11.8)7 (31.8)4 (8.0)
           Memantine00001 (2.0)
           Rivastigmine1 (8.3)01 (5.9)1 (4.6)3 (6.0)
        Newfoundland and Labrador
        No. of medications*
           0271 (92.8)253 (86.6)227 (77.7)207 (70.9)207 (70.9)
           120 (6.9)34 (11.6)62 (21.2)83 (28.4)83 (28.4)
           204 (1.4)3 (1.0)1 (0.3)2 (0.7)
           3-41 (0.3)1 (0.3)01 (0.3)0
        Type of medication†
           Donepezil6 (66.7)7 (77.8)16 (64.0)29 (65.9)75 (88.2)
           Galantamine3 (33.3)2 (22.2)9 (36.0)22 (50.0)16 (18.8)
           Memantine1 (11.1)1 (11.1)5 (20.0)1 (2.3)0
           Rivastigmine2 (22.2)01 (4.0)2 (4.6)1 (1.2)
        Nova Scotia
        No. of medications*
           0491 (89.9)468 (85.7)429 (78.6)383 (70.2)397 (72.7)
           151 (9.3)73 (13.4)110 (20.2)154 (28.2)139 (25.5)
           24 (0.7)5 (0.9)7 (1.3)8 (1.5)10 (1.8)
           3-40001 (0.2)0
        Type of medication†
           Donepezil7 (53.9)2 (18.2)14 (53.9)38 (56.7)90 (60.4)
           Galantamine4 (30.8)9 (81.8)16 (61.5)29 (43.3)62 (41.6)
           Memantine1 (7.7)01 (3.9)3 (4.5)8 (5.4)
           Rivastigmine1 (7.7)02 (7.7)7 (10.5)17 (11.4)
        Ontario
        No. of medications*
           01934 (92.8)1812 (86.9)1678 (80.5)1589 (76.2)1557 (74.7)
           1135 (6.5)248 (11.9)357 (17.1)432 (20.7)459 (22.0)
           214 (0.7)23 (1.1)49 (2.4)62 (3.0)66 (3.2)
           3-42 (0.1)2 (0.1)1 (0.1)2 (0.1)3 (0.1)
        Type of medication†
           Donepezil25 (67.6)30 (63.8)68 (58.6)138 (60.3)343 (62.9)
           Galantamine8 (21.6)18 (38.3)49 (42.2)81 (35.4)191 (35.1)
           Memantine4 (10.8)5 (10.6)15 (12.9)45 (19.7)95 (17.4)
           Rivastigmine3 (8.1)7 (14.9)12 (10.3)27 (11.8)59 (10.8)

        *Dementia medications are donepezil, galantamine, memantine and rivastigmine.

        †Totals may exceed 100% because some patients were prescribed more than 1 medication.

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        Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network
        Neil Drummond, Richard Birtwhistle, Tyler Williamson, Shahriar Khan, Stephanie Garies, Frank Molnar
        Apr 2016, 4 (2) E177-E184; DOI: 10.9778/cmajo.20150050

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        Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network
        Neil Drummond, Richard Birtwhistle, Tyler Williamson, Shahriar Khan, Stephanie Garies, Frank Molnar
        Apr 2016, 4 (2) E177-E184; DOI: 10.9778/cmajo.20150050
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