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Document Type

Original Article

Abstract

ABSTRACT BACKGROUND Fugitive diagnosis “escape from true diagnosis” of neurological disorders is very common in elderly patients. It’s not always an underlying disease symptom or progression in old age. Aim of this study is to determine the frequency and nature of fugitive diagnosis of neurodegenerative brain disorders in old age. MATERIAL AND METHODS STUDY DESIGN A study was conducted in private Neuro-clinic in Lahore. Study duration is 3 years from to 1st January, 2017 to 31th December, 2019. It was a prospective, cross sectional study. Inclusion criteria: 1) Age >60years 2) Neurodegenerative brain disorders including vascular dementia 3) with or without associated co morbidities e.g., DM, HTN, IHD. Exclusion criteria: age <60, all acquired other neurological disorder RESULTS Total number of patients (n=2570) visited to Neuro-clinic with various neurological disorders.950 patients had neurodegenerative diseases. A total of 241 patients(n=241) with neurodegenerative diseases like Parkinson’s disease, Alzheimer’s disease, Lewy body disease vascular dementia and fronto-temporal dementia having fugitive diagnosis during their course of treatment were included in the study. Study sample consisted of 134 males and 107 female patients. The patients included in study were aged equal to or more than 60 years. True diagnosis was as follows; refusal to take oral medications or keeping food in mouth 73/241, (30.29%), misdiagnosed as advanced dementia or early Alzheimer’s disease, Serotonin Syndrome 23/241, (09.54%), Subacute Encephalopathy 67/241, (27.80%) caused by infections e.g. urinary tract infection or pneumonia, hyponatremia, were taken as advanced widespread disease or deepening encephalopathy due to metabolic cause, Depression in 47/241, (19.50%), was taken as worsening of symptoms or polypharmacy. Impulse control disorders 31/241, (12.86%) were misdiagnosed as extremes of behavior with efforts leading to hospitalization in psychiatric institution. CONCLUSION Fugitive diagnosis in patients with neurologic symptoms and signs, especially in neurodegenerative disorders results in worsening of patient condition with no chance of benefit. The patient is subjected to inappropriate, ineffective and potentially harmful treatment. Fugitive diagnosis fails to address symptoms, delays appropriate therapy, and may lead to worst prognosis. Finally, it may lead to unnecessary higher cost of treatment for patient in particular and health care system in general. So clinical guidelines should be made to overcome these situations.

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