Objectives Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates.
Methods/setting/participants A systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation.
Primary and secondary outcome measures The outcome measures of interest were the prevalence and determinants of undetected dementia.
Results 23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7% (95% CI 55.0% to 68.0%). The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria.
Conclusions The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.
- GERIATRIC MEDICINE
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▸ Additional material is available. To view please visit the journal online (http://dx.doi.org/10.1136/bmjopen-2016-011146).
AC is co-first author.
Contributors RC created a research idea for this study and made its conception and design. LL and AC were involved in the conception and design of this study, and contributed to the literature search and review. ID and WZ searched and reviewed the literature of 2013–2016. LW and DZ and RC were responsible for quantitative data analysis. JC, KJA, DL and GA contributed, along with all other authors, equally to the interpretation of the results and discussion of their implications. All authors were substantially involved in the writing and revisions of this manuscript, and all have given approval of the final version.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.