Diagnosis of Dementia in Primary Care: A Representative Survey of Family Physicians and Neuropsychiatrists in Germany

Abstract

Aim: To measure the diagnostic competence of family physicians (FP) and neuropsychiatrists (NP) for moderate dementia. Methods: Written case vignettes describing moderate dementia either of Alzheimer type or vascular type were randomized to a representative sample of 122 FP and 68 NP, corresponding to response rates of 71.8 and 67.3%, respectively. They served as the basis for a structured face-to-face interview. Results: NP and FP did not differ with regard to their diagnostic considerations, however, concerning diagnostic workup. Vascular dementia was much better recognized than dementia of Alzheimer type. Neuropsychological tests and brain imaging would be done by 14.8 and 32.8% of the FP in the case of vascular dementia. In Alzheimer dementia they would apply these methods in 24.6 and 19.7%, respectively. The corresponding numbers for NP were about 60% in both cases for testing and more than 80% for brain imaging. Conclusions: There is still a wide gap between guidelines and practice in primary care. The apparent overdiagnosis of vascular dementia may be one reason for the low drug treatment rates.

Diagnostic Evaluation of Dementia in the Secondary Health Care Sector

“…Dementia specialists documented history of cognitive symptoms in 90% and did cognitive tests in 70-80% of the patients ( table 3 ). Similarly, Italian and German studies showed that neurologists and neuropsychiatrists did cognitive tests in 90 and 60% of the patients, respectively [22,23] . Psychiatrists satisfactorily performed psychiatric evaluation (97%) but neurologists and geriatricians did not (60-70%).…”

“…Psychiatrists satisfactorily performed psychiatric evaluation (97%) but neurologists and geriatricians did not (60-70%). Similarly, neurologists in the USA and in Italy followed guidelines concerning identification of depression in 80 and 60% of the time, respectively [23,24] . Psychiatrists and geriatricians did not perform neurological examination in 30-60% of the patients ( table 3 ), and 10-20% of the patients diagnosed as having dementia by the dementia specialists did not have a cranial CT or MRI.…”

Neurological and Psychiatric Practitioners’ Views on Alzheimer’s Disease and Treatment Thereof

“…Frequently, practitioners in private practice incompletely adhere to guidelines issued by Medical Associations [11][12][13][14] . Further research is needed to explore in depth the reasons for discrepancies between guidelines and everyday practice [15] .…”

Health Among the Elderly in Germany. New Evidence on Disease, Disability and Care Need

“…The second explanation is that the difference between NP patients and GP patients in terms of the amount of time it takes them to transition to LTC is attributable to the different treatments they receive. A diagnostic workup by an NP is more likely to conform to the guidelines, which may lead to a more accurate diagnosis of the dementia type (Stoppe et al 2007), and thus to a more appropriate treatment being prescribed. The present study only looks at the effect of the diagnosing physician in the quarter in which the initial diagnosis was made.…”