Differences in diagnostic process, treatment and social Support for Alzheimer's dementia between primary and specialist care: resultss from the Swedish Dementia Registry.
the increasing prevalence of Alzheimer's dementia (AD) has shifted the burden of management towards primary care (PC). Our aim is to compare diagnostic process and management of AD in PC and specialist care (SC).



cross-sectional study.



a total of, 9,625 patients diagnosed with AD registered 2011-14 in SveDem, the Swedish Dementia Registry.



descriptive statistics are shown. Odds ratios are presented for test performance and treatment in PC compared to SC, adjusted for age, sex, Mini-Mental State Examination (MMSE) and number of medication.



a total of, 5,734 (60%) AD patients from SC and 3,891 (40%) from PC. In both, 64% of patients were women. PC patients were older (mean age 81 vs. 76; P < 0.001), had lower MMSE (median 21 vs. 22; P < 0.001) and more likely to receive home care (31% vs. 20%; P < 0.001) or day care (5% vs. 3%; P < 0.001). Fewer diagnostic tests were performed in PC and diagnostic time was shorter. Basic testing was less likely to be complete in PC. The greatest differences were found for neuroimaging (82% in PC vs. 98% in SC) and clock tests (84% vs. 93%). These differences remained statistically significant after adjusting for MMSE and demographic characteristics. PC patients received less antipsychotic medication and more anxiolytics and hypnotics, but there were no significant differences in use of cholinesterase inhibitors between PC and SC.



primary and specialist AD patients differ in background characteristics, and this can influence diagnostic work-up and treatment. PC excels in restriction of antipsychotic use. Use of head CT and clock test in PC are areas for improvement in Sweden.
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden.|Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden.
Sara
S
Garcia-Ptacek
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden.
Ingrid Nilsson
IN
Modéer
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet and Stockholm University, Stockholm, Sweden.|Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
Ingemar
I
Kåreholt
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden.|Department of Neurology and Neurosurgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
Seyed-Mohammad
SM
Fereshtehnejad
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden.
Bahman
B
Farahmand
Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden.|Division for Neurogeriatrics,  Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Sweden.
Dorota
D
Religa
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden.|Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden.
Maria
M
Eriksdotter
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D009483:Neuropsychological Tests; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care; D017064:Process Assessment, Health Care; D012017:Referral and Consultation; D012042:Registries; D012944:Social Support; D013038:Specialization; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D006993:Hypnotics and Sedatives
Alzheimer's; care systems; dementia; diagnosis; older people; primary care