INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2003; 18: 915–924. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.946 Diagnosis-seeking at subspecialty memory clinics: trigger events Megan E. Streams 1 , Sarah B. Wackerbarth 1 * and Alan Maxwell 2 1 Martin School of Public Policy and Administration, University of Kentucky 419 Patterson Office Tower, Lexington, KY 40506-0027, USA 2 Family Medicine Program, University of Alabama School of Medicine, Huntsville, Alabama, USA SUMMARY Background Research has shown that dementia often goes unrecognized, and diagnostic assessment is often further delayed. Understanding families’ decision to seek care at memory clinics is relevant to efforts to facilitate early diagnosis Objective To examine the population seeking care at two memory clinics and the triggers causing caregivers to seek diag- nostic assessment for a family member. Method We surveyed a consecutive sample of caregivers who accompanied a patient to an assessment at two university memory disorders clinics. Caregivers (n ¼ 416) described events that led them to seek a memory assessment for the patient, as well as who first suggested an assessment and diagnosis received. Results Changes in the patient (cognitive, personality/behavioral, physical, or unspecified) accounted for 81% of 903 trig- ger events reported. Nearly half of the caregivers noting specific patient changes recorded some combination, rather than cognitive changes alone. Of the 338 respondents who noted a change in the patient as a trigger, 85% specified at least one cognitive change, while 40% specified at least one personality/behavioral change. Memory loss was most frequent trigger reported, followed by disorientation and recommendations (lay or professional). Caregivers themselves and non-specialist physicians were the most frequent sources of recommendations noted by all respondents. Conclusion A broad range of trigger events, beyond cognitive or symptomatic changes, caused caregivers to seek diag- nosis at a memory clinic. Awareness of triggers significant to families may help physicians reduce the number and severity of events needed to convince caregivers a memory assessment is indicated. Copyright # 2003 John Wiley & Sons, Ltd. key words — dementia; caregivers; diagnosis; decision making; questionnaires INTRODUCTION Alzheimer’s disease (AD), the most common cause of dementia, is estimated to affect between 6 and 8% of individuals over age 65 (Small et al., 1997). Its preva- lence is expected to increase as the population ages (Albert and Drachman, 2000). Despite the lack of a cure, a case has been made for the potential benefits of early diagnosis (Costa et al., 1996; Small et al., 1997; Daffner and Scinto, 2000). Dementia symptoms may have another cause that could be treated, or comorbid conditions may be addressed (Larson et al., 1984). If the diagnosis is probable AD, treat- ments may ameliorate symptoms in some individuals (Small, 1998), and interventions may be available to help with behavioral issues (Rabins et al., 1982). The family and the patient may be able to make decisions regarding future care and legal matters prior to severe cognitive decline of the affected individual (Costa et al., 1996). Several paths can lead to early diagnosis of demen- tia. Guidelines regarding early diagnosis of AD and related disorders enumerate the signs to which health professionals should be alert (Costa et al., 1996). Thus, physicians may recognize and investigate dementia in patients they see for other reasons, in gen- eral practice or upon hospitalization (Incalzi et al., Received 31 July 2002 Copyright # 2003 John Wiley & Sons, Ltd. Accepted 23 June 2003 * Correspondence to: Dr S. B. Wackerbarth, Martin School of Public Policy and Administration, University of Kentucky, 419 Patterson Office Tower, Lexington, KY 40506-0027, USA. Tel: 859-257-5145. Fax: 859-323-1937. E-mail: sbwack0@uky.edu Contract/grant sponsor: Alzheimer’s Association Investigator Initiated Awards Program; contract/grant number: IIRG-98-070.