Diagnosis of dementia in primary care: a representative survey of family physicians and neuropsychiatrists in Germany.

Aim: To measure the diagnostic competence of family physicians (FP) and neuropsychiatrists (NP) for moderate dementia.

Methods: Written case vignettes describing moderate dementia either of Alzheimer type or vascular type were randomized to a representative sample of 122 FP and 68 NP, corresponding to response rates of 71.8 and 67.3%, respectively. They served as the basis for a structured face-to-face interview.

Results: NP and FP did not differ with regard to their diagnostic considerations, however, concerning diagnostic workup. Vascular dementia was much better recognized than dementia of Alzheimer type. Neuropsychological tests and brain imaging would be done by 14.8 and 32.8% of the FP in the case of vascular dementia. In Alzheimer dementia they would apply these methods in 24.6 and 19.7%, respectively. The corresponding numbers for NP were about 60% in both cases for testing and more than 80% for brain imaging.

Conclusions: There is still a wide gap between guidelines and practice in primary care. The apparent overdiagnosis of vascular dementia may be one reason for the low drug treatment rates.