Dementia diagnostics in primary care: a representative 8-year follow-up study in Lower Saxony, Germany.
OBJECTIVE
To investigate whether primary-care physicians' competency regarding dementia diagnostics improved from 1993 to 2001.


METHODS
In a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) were randomly assigned to 2 written case samples presenting patients with slight memory impairment (case 1a: female vs. case 1b: male) and moderate dementia [vascular type (case 2a) vs. Alzheimer's disease (case 2b)]. Potential diagnostic workup was inquired by a structured face-to-face interview.


RESULTS
'Basic' diagnostics like history taking or laboratory investigations were considered in the first place. In case 1, neuropsychological screening was significantly more frequently considered at follow-up (19.3% in 1993 vs. 31.1% in 2001); it still would have been applied rarely in case 2 (2a: 14.1 vs. 14.8%; 2b: 23.5 vs. 24.6%). Neuroimaging remained not to be considered as a standard procedure, and only a minority of FPs would have performed a screening for depression (2001: 1a: 6.7%; 1b: 11.3%; 2a: 0.0%; 2b: 1.6%).


CONCLUSIONS
With regard to dementia diagnostics in primary care, guideline adherence remained low at follow-up. Structured training efforts aiming at FPs appear to be necessary.
Maeck
Lienhard
L
University Psychiatric Hospitals, Basel, Switzerland.
Haak
Sebastian
S
Knoblauch
Anita
A
Stoppe
Gabriela
G
D000368:Aged; D002391:Catchment Area, Health; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology*; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008487:Medical History Taking; D009460:Neurologic Examination; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*