From suspicion of cognitive decline to dementia diagnosis: a systematic review of healthcare professionals' considerations and attitudes.

Background: Initiating diagnostic testing for dementia is a dynamic and complex process that often involves balancing competing interests. This systematic review aims to provide an overview of healthcare professionals' considerations and attitudes during the process from suspicion of cognitive decline to deciding to initiate diagnostic testing.

Methods: Databases (PubMed, EMBASE, CINAHL and PsychINFO) were systematically searched on 29 January 2024 for qualitative and mixed-methods studies published since 2005. Search concepts were: 'dementia', 'considerations and attitudes', 'healthcare professionals' and 'diagnosis'. Two screeners independently conducted title/abstract-screening using ASReview (efficient and transparent systematic review machine learning framework), and full-text screening. Findings were analysed by thematic synthesis.

Results: Thirty-three studies were included. Most involved primary care physicians (n = 25), primary care nurses (n = 1) or a combination (n = 7). The overarching phenomenon was that starting the diagnostic workup for dementia is a delicate process. Clusters influencing this process were: complexities arising from the nature of dementia; interaction with the patient and family; individual determinants of primary care practitioners (PCPs); expectations regarding the consequences of a diagnosis; factors related to the healthcare system; and societal factors. Together these clusters form PCPs' strategies and actions for deciding whether to start the diagnostic workup.

Conclusion: Initiating the diagnostic workup for dementia is a delicate process influenced by various factors including fear, reluctance and stigma. The different strategies that PCPs use cannot be captured by a single right approach. Recommendations to better support PCPs in navigating this complex process include ensuring consistent communication and clarity about their roles, and promoting interprofessional collaboration.