[Diagnosis of dementia--an objective examination or a subjective evaluation?]

Case records of 404 elderly patients (aged 65 years or more) who were admitted for the first time to the Psychiatric Hospital in Aarhus, with a diagnosis of dementia were investigated retrospectively. In 315 patients the diagnoses were confirmed as senile dementia (290.09) or arteriosclerotic dementia (293.09) according to ICD-8. Eighty-seven patients had their diagnosis changed in the course of the case review. When case records of these 87 patients were investigated for the second time, four patients were diagnosed as demented: 66 patients were admitted because of confusion, 26 patients were diagnosed depressive, 10 of these manic-depressive. This investigation shows uncertainty and a tendency to overdiagnose of dementia, especially in the early stages. A wrong diagnosis may lead to therapeutic nihilism, especially when the patient suffers from confusion and/or depression.