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LETTER TO THE EDITOR Early diagnosis of dementia in primary care Dear Editor We appreciate that Dr Spiegel considers our paper and the method as interesting and important for the benchmarking with regard to specialisation and changes over time. However, he does not share our concerns regarding the apparent overemphasis of vascular aetiology, because it would be sufficient that a family physician’s suspicion is raised. This would be plausible, when a patient would undergo a thorough diagnostic work-up afterwards. However, as discussed in our paper, this is not the case. In addition, referral to a specialist is not the rule. Thus, as we pointed out, the overestimation of vascular aetiology might be one (important) reason for the undertreatment with the only evidence-based drugs for early Alzheimer dementia, the cholinesterase inhibitors (Burns et al., 2006). He encourages the comparison with specialists and the measurement of an overall recognition rate. While the latter would need another study design, we had a specialists control group, at least in the latter survey. The changes over time are available only for the family physicians, as pointed out in the paper. The comparison with a representative sample of specialists will be published separately (Stoppe et al., in press; Stoppe et al., 2007). REFERENCES Burns A, O’Brien J, on behalf of the BAP Dementia Consensus Group. 2006. Clinical practice with anti-dementia drugs: a con- sensus statement from British Association for Psychopharma- cology. J Psychopharmacol 20: 732–755. Stoppe G, Haak S, Knoblauch A, Maeck L. 2007. Diagnosis of dementia in primary care: a representative survey of family physicians and neuropsychiatrists in Germany. Dement Geriatr Cognitive Disord 23: 207–214. Stoppe G, Knoblauch A, Haak S, Maeck L. Physicians’ competence for the early diagnosis of dementia: Differences between family physicians and primary care neuropsychiatrists in Germany. Psychiat Prax (in press) (German). PROF .DR GABRIELA STOPPE DR LIENHARD MAECK University Psychiatric Hospitals Wilhelm Klein-Strasse 27 CH-4025 Basel E-Mail: [email protected] Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/gps.1802 INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int. J. Geriatr. Psychiatry 2007; 22: 498 Copyright # 2007 John Wiley & Sons, Ltd.

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Page 1: Early diagnosis of dementia in primary care

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY

Int. J. Geriatr. Psychiatry 2007; 22: 498

LETTER TO THE EDITOR

Early diagnosis of dementia in primary care

Dear Editor

We appreciate that Dr Spiegel considers our paperand the method as interesting and important forthe benchmarking with regard to specialisation andchanges over time. However, he does not share ourconcerns regarding the apparent overemphasis ofvascular aetiology, because it would be sufficient thata family physician’s suspicion is raised. This would beplausible, when a patient would undergo a thoroughdiagnostic work-up afterwards. However, as discussedin our paper, this is not the case. In addition, referralto a specialist is not the rule. Thus, as we pointed out,the overestimation of vascular aetiology might be one(important) reason for the undertreatment with theonly evidence-based drugs for early Alzheimerdementia, the cholinesterase inhibitors (Burns et al.,2006).He encourages the comparison with specialists

and the measurement of an overall recognitionrate. While the latter would need another studydesign, we had a specialists control group, at least inthe latter survey. The changes over time are availableonly for the family physicians, as pointed out in thepaper. The comparison with a representative sample ofspecialists will be published separately (Stoppe et al.,in press; Stoppe et al., 2007).

Copyright # 2007 John Wiley & Sons, Ltd.

REFERENCES

Burns A, O’Brien J, on behalf of the BAP Dementia ConsensusGroup. 2006. Clinical practice with anti-dementia drugs: a con-sensus statement from British Association for Psychopharma-cology. J Psychopharmacol 20: 732–755.

Stoppe G, Haak S, Knoblauch A, Maeck L. 2007. Diagnosis ofdementia in primary care: a representative survey of familyphysicians and neuropsychiatrists in Germany. Dement GeriatrCognitive Disord 23: 207–214.

Stoppe G, Knoblauch A, Haak S, Maeck L. Physicians’ competencefor the early diagnosis of dementia: Differences between familyphysicians and primary care neuropsychiatrists in Germany.Psychiat Prax (in press) (German).

PROF. DR GABRIELA STOPPE

DR LIENHARD MAECK

University Psychiatric Hospitals

Wilhelm Klein-Strasse 27

CH-4025 Basel

E-Mail: [email protected]

Published online in Wiley InterScience(www.interscience.wiley.com)

DOI: 10.1002/gps.1802

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