The fuzzy frontier between subjective memory complaints and early dementia. A survey of patient management in German memory clinics.
BACKGROUND
Mild cognitive decline is frequent in the elderly population. Whether it is related to normal aging or an early phase of evolving dementia is difficult to ascertain with confidence, and accordingly there is a lack of consensus guidelines for diagnosis and therapy in such patients. We assessed the variability with which memory clinics deal with this problem in everyday practice.


METHODS
We sent three fictitious case histories to all 85 German memory clinics that contained the results of clinical examination and neuropsychological test scores and asked for diagnosis and patient management. Patient 1 presented with complaints of mental decline but normal neuropsychological and neurological evaluation and normal daily living activities. Patient 2 came in as a control subject for a study and had impaired test scores but preserved daily living activities, and patient 3 was brought in by relatives with slight impairment of daily living activities and decline in some neuropsychological test scores but relatively spared memory scores.


RESULTS
Most of the 51 respondents agreed in recommending further neuropsychological testing, a basic laboratory work-up, brain imaging, and a re-examination after 3-6 months. Yet, there was a high variability in the diagnostic terms used, in the additional diagnostic procedures proposed, and in the recommendations concerning therapeutic intervention and driving.


CONCLUSIONS
The results reveal a need of practice guidelines for the use of diagnostic terms, therapeutic interventions and driving recommendations in patients between subjective memory complaints and early dementia.
Rösler
A
A
Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. Alexander.Roesler@kgu.de
Gönnenwein
C
C
Müller
N
N
Sterzer
P
P
Kleinschmidt
A
A
Frölich
L
L
D000203:Activities of Daily Living; D000368:Aged; D001334:Automobile Driving; D003704:Dementia / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D009483:Neuropsychological Tests; D011795:Surveys and Questionnaires; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed