title: Trends of patient referral to a memory clinic and towards earlier diagnosis from 1985-2009.
abstract: BACKGROUND
  It may be assumed that increased public awareness of dementia due to Alzheimer's disease (AD) together with the availability of efficacious treatment will result in diagnostic evaluation at earlier stages of cognitive decline and diagnosis of dementia due to AD at earlier stages.
  
  
  METHODS
  All persons that were examined at a university based memory clinic, in Germany, between 1985 and 2009 were included.
  
  
  RESULTS
  In the 3,951 persons identified, linear regression analysis revealed a positive association between Mini Mental State Examination (MMSE) score and year of initial examination (yearIE) (β = 0.266; p < 0.001). In the 1,821 patients diagnosed with dementia due to AD, a positive association between MMSE score and yearIE (β = 0.230; p < 0.001) was revealed. MMSE scores were higher (β = 0.195; p < 0.001) after the introduction of cholinesterase inhibitors in Germany in 1997.
  
  
  CONCLUSIONS
  Diagnostic evaluation of individuals occurred at progressively earlier stages of cognitive decline. Dementia due to AD was diagnosed at progressively earlier stages, and this trend was associated with the availability of efficacious treatment. This is the first study on changes in patient referral and diagnosis based on a continuous 25 years period.
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Grimmer
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Beringer
authors.affiliation: Institute for Medical Statistics and Epidemiology,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Victoria
authors.initials: V
authors.lastname: Kehl
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Alexopoulos
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Aurel
authors.initials: A
authors.lastname: Busche
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Förstl
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Goldhardt
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Bianca
authors.initials: B
authors.lastname: Natale
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Ortner
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Peters
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Lina
authors.initials: L
authors.lastname: Riedl
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Carola
authors.initials: C
authors.lastname: Roßmeier
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Valentin
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Diehl-Schmid
authors.affiliation: Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar der Technischen Universität München,Ismaninger Str. 22,81675 Munich,Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kurz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000188:drug therapy; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D005544:Forecasting; D005858:Germany; D006801:Humans; D016014:Linear Models; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation / Q000639:trends*; D055815:Young Adult
chemical_list: D002800:Cholinesterase Inhibitors
keywords: Alzheimer’s disease (AD); dementia; early diagnosis; mini-mental state examination (MMSE); trends of patient referral