title: [Dementia guidelines: what should come to general practice--an interdisciplinary consensus of physicians in private practice].
abstract: BACKGROUND
  Guidelines of Medical Societies aim at supporting the quality of medical care in general, and particularly in private practice. Usually, physicians in private practice are not part of the expert committees of medical societies that author guidelines. Guidelines represent a consensus appraising evidence from clinical studies on efficacy and side effects but also evaluating aspects of the health care system such as costs. Guidelines commonly do not account for regional specifics. Transfer of knowledge from guidelines to general practice, therefore, is incomplete.
  
  
  METHODS
  We describe a consensus of neuropsychiatric and general physicians (n=12; 10 to 38 years of professional experience) on prioritization of diagnostic and therapeutic procedures for patients with Alzheimer's dementia as judged by relevance and practicability compared to the guideline of the Society for General Medicine (DEGAM-guideline No. 12) and the S3-guideline dementia of the German Society for Psychiatry, Psychotherapy and Neuropsychiatry (DGPPN).
  
  
  RESULTS
  If patients and proxies do not oppose diagnosis, e. g. in cases of progressive impairment of memory with everyday relevance, the appropriate diagnostic procedures should be performed for every patient. Age or setting in which the patients live, in itself are no reason to limit antidementia therapy. Symptom fluctuations or decline of individual symptoms are compatible with treatment success. Clinical scales may only be used as supportive means to evaluate disease progression.
  
  
  CONCLUSIONS
  Diagnosis and treatment of dementia are experienced as complex tasks by physicans in private practice. Practicing physicians need to adapt guidelines of medical societies on local and individual specifics.
authors.affiliation: Klinik für Psychiatrie II, Sektion Gerontopsychiatrie, Universität Ulm. matthias.riepe@uni-ulm.de
authors.forename: M W
authors.initials: MW
authors.lastname: Riepe
authors.forename: A
authors.initials: A
authors.lastname: Fellgiebel
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000628:therapy*; D032921:Consensus; D003299:Cooperative Behavior; D058006:General Practice; D005858:Germany; D006297:Health Services Accessibility; D006801:Humans; D033183:Interdisciplinary Communication; D058027:Neuropsychiatry; D011331:Private Practice