Early diagnosis of dementia in primary care: a representative eight‐year follow‐up study in Lower Saxony, Germany

Objective To investigate whether primary care competency in early diagnosis of dementia might have changed during 1993 and 2001. Method By means of a representative follow‐up survey 122 out of 170 (71.8%) family physicians (FPs) in Lower Saxony, Germany, were randomly assigned to two written case samples presenting a patient with mild cognitive impairment (case 1a vs . 1b: female vs . male patient) and moderate dementia (case 2a vs 2b: vascular type (VD) vs Alzheimer's disease (DAT)), respectively. By means of a structured face‐to‐face interview, they were asked for their diagnostic considerations. Results In comparison to 1993, dementia was significantly more frequently considered. However, there was a striking tendency in overestimating vascular aetiology and under‐diagnosing probable DAT (case 1a/1b: DAT: 11.0% in 1993 vs 26.2% in 2001; VD: 2.1% in 1993 vs 17.2% in 2001). As a possible contributor to a dementia syndrome, concomitant medication was considered only exceptionally (case 2a/2b: 4.4% in 1993 vs 2.5% in 2001). Physicians above 50 years of age showed a significantly lower early diagnostic awareness. At follow‐up, the presumed interest in geriatric (psychiatric) topics dramatically faded from 66.9% to 35.2%. Conclusions Our results demonstrate a persistent need of training efforts aiming at the early recognition of dementia, especially of DAT, in primary care. Copyright © 2006 John Wiley & Sons, Ltd.