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Underrecognition of Dementia by Caregivers Cuts Across Cultures

Lydia H. Greiner, BSN, RN; David A. Snowdon, PhD
JAMA. 1997;277(22):1757. doi:10.1001/jama.1997.03540460023014.
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To the Editor.  —The article by Dr Ross and colleagues1 indicates that 21% of family informants failed to recognize memory problems in noninstitutionalized elderly Japanese-American men who were subsequently found to have dementia. This high prevalence of unrecognized dementia is disturbing given that recognition of a problem is the first step in appropriately caring for a patient.We suspected that a significant percentage of professional caregivers also would fail to recognize dementia. Furthermore, we were concerned that caregivers might label some nondemented older adults as demented.We investigated these issues in 678 white Catholic sisters of European ancestry who are participants in the Nun Study, a longitudinal study of aging and Alzheimer disease.2-4 Each year, participants complete a standard battery of tests to assess cognitive function and identify dementia. In addition, each sister agreed to donate her brain at death for neuropathologic evaluation. As described elsewhere,3 clinical


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