A survey of physician practices in managing people with dementia in Hong Kong

Abstract

Background and Objectives: Managing patients with dementia (PWD) in accordance with established clinical practice guidelines is important in providing optimal care. However, information about the actual processes of diagnosis and treatment is scanty. The objective of this paper is to explore the daily practices and management of PWD by physicians in Hong Kong. Methods: A survey was conducted to explore the practices of local physicians in managing PWD. A questionnaire was sent to the Hong Kong Medical Association, which represents 61% of all locally registered medical practitioners. Results: The Mini-Mental State Examination (MMSE) was the most common screening instrument (89.4%), followed by the Clock drawing test (29.3%). The most frequently used imaging tests were computed tomography (67.9%). Tests for thyroid-stimulating hormones (85.9%) and vitamin B12 (74.9%), as well as the Venereal Disease Research Laboratory Test (74.9%), were frequently performed to rule out reversible causes. Cholinesterase inhibitor (69.7%) and N-Methyl-D-asparate (44.1%) were the most commonly used anti-dementia medications. The most common reason for referring patients to specialists was the “occurrence of severe behavioral and psychiatric symptoms (BPSD)” (59.6%). Discussion: Most physicians in Hong Kong can select cognitive assessment tools, laboratory tests, and imaging tests recommended by several practice guidelines. Primary care physicians should be able to manage PWD who are in stable condition and without severe BPSD. Better education of physicians in the diagnosis and management of dementia is needed to ensure that all physicians practice in ways consistent with the established practice guidelines.