Early diagnosis of dementia in primary care: a representative eight-year follow-up study in Lower Saxony, Germany.
OBJECTIVE
To investigate whether primary care competency in early diagnosis of dementia might have changed during 1993 and 2001.


METHODS
By means of a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) in Lower Saxony, Germany, were randomly assigned to two written case samples presenting a patient with mild cognitive impairment (case 1a vs. 1b: female vs. male patient) and moderate dementia (case 2a vs 2b: vascular type (VD) vs Alzheimer's disease (DAT)), respectively. By means of a structured face-to-face interview, they were asked for their diagnostic considerations.


RESULTS
In comparison to 1993, dementia was significantly more frequently considered. However, there was a striking tendency in overestimating vascular aetiology and under-diagnosing probable DAT (case 1a/1b: DAT: 11.0% in 1993 vs 26.2% in 2001; VD: 2.1% in 1993 vs 17.2% in 2001). As a possible contributor to a dementia syndrome, concomitant medication was considered only exceptionally (case 2a/2b: 4.4% in 1993 vs 2.5% in 2001). Physicians above 50 years of age showed a significantly lower early diagnostic awareness. At follow-up, the presumed interest in geriatric (psychiatric) topics dramatically faded from 66.9% to 35.2%.


CONCLUSIONS
Our results demonstrate a persistent need of training efforts aiming at the early recognition of dementia, especially of DAT, in primary care.
Maeck
Lienhard
L
University Psychiatric Hospitals, Basel, Switzerland.
Haak
Sebastian
S
Knoblauch
Anita
A
Stoppe
Gabriela
G
D000328:Adult; D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis; D002983:Clinical Competence / Q000592:standards*; D003704:Dementia / Q000175:diagnosis*; D015140:Dementia, Vascular / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards* / Q000639:trends