Diagnosis of dementia by different specialties

The present study was undertaken to describe, explore and compare the specific methods and services provided by physicians of different specialties (general practitioners, geriatricians, neurologists, psychiatrists and geriatric psychiatrists) in the evaluation process of patients with suspected dementia in Israel. A self-administered questionnaire--mailed to 203 physicians (response rate 37%)--included items covering medical and specialty training, numbers of patients examined, evaluation approaches, use of formal diagnostic criteria, use of mini-mental tests, use of dementia severity rating scales, use of psychiatric and behavioral rating scales, and the use of laboratory examinations. Results indicate that the majority of physicians in all specialties either provided history taking, physical and neurological examination, or referred for it elsewhere. Deficiencies were noted regarding the use of psychiatric examination by the nonpsychiatric specialties, and provision of ADL evaluation by all specialties (except geriatricians). All specialties made a minimal use of neuropsychological tests. DSM-3/DSM-3R criteria for dementia were widely used by all specialties (except general practitioners). MMSE was the most widely used brief cognitive screening test. However, only a minority of general practitioners and psychiatrists made use of it. Laboratory tests in dementia evaluation were widely used by most physicians, irrespective of specialty. Further research is needed in order to define in more specific terms the advantages contributed by each specialty separately and in collaboration to the diagnostic process of dementia.