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Alzheimer's disease and dementing disorders: Practices and experiences of rural physicians

This paper presents information on rural primary care physicians' diagnoses, the procedures used, treatment recommendations, as well as reported advantages and disadvantages ofpracticing in a rural setting and managing patients with Alzheimer's disease and dementing disorders. A total of 102 primary care physicians in rural Illinois counties were interviewed (response rate = 72.3 percent). There was considerable variability in physicians' responses to the causes of dementia syndrome and the procedures used in making a diagnosis. When questioned in an open-ended format about possible causes of dementing disorders, physicians mostfrequently mentioned Alzheimer's disease (80 percent), multi-infarct dementia (56percent), and drug toxicity (53 percent). “Non-specific” causes were also mentioned, including arteriosclerosis (36 percent), organic brain syndrome (27 percent), and old age (25 percent). Laboratory tests and CT scans were most often used in the diagnostic process. Less than 10 percent of the physicians used more formal, cognitive screening tests like the Mini-Mental State Exam. Less than one-half of the physicians had previously recommended nursing home placement in the management of their dementia patients. Physician age, practice type (solo/group) and specialty (internal/family medicine) were associated with some of the physicians' responses regarding dementia causes and procedures used in diagnosis. The rural setting was viewed as inadequate with regard to laboratory facilities and supportpersonnel as well as problematic in requiring long distance travel for consultation. On the other hand, the rural community provided an advantage over the urban in opportunities for support and cooperation forfamilies andfriends to assist in managing the care ofdementia disorder patients. Alzheimer's disease and other dementias present the problem of uncertainty at many levels including medical, patient outcome, and family management issues. In the rural setting, the physician often represents the entire health professions community. It is imperative that rural physicians be prepared to both diagnose and, in turn, manage the complex and difficultsituation created by dementia syndrome.