Who diagnoses dementia?

Who Diagnoses Dementia

Dementia is typically diagnosed by a range of healthcare professionals, with primary care providers making approximately 85% of initial diagnoses, while specialists such as neurologists, geriatricians, geriatric psychiatrists, and other specialists manage more complex cases.1

Primary Care Providers

• Primary care physicians (PCPs) are the most common first-line diagnosticians for dementia, responsible for approximately 85% of dementia diagnoses 1
• PCPs often conduct initial assessments including history-taking, cognitive testing, physical examination, and basic laboratory tests 1
• Many PCPs refer patients to specialists when cases are complex or when specialized testing is needed 2

Specialists Involved in Dementia Diagnosis

• Neurologists evaluate patients with suspected dementia, particularly when neurological symptoms are prominent or the diagnosis is unclear 1, 2
• Geriatricians specialize in diagnosing and managing dementia in older adults with multiple comorbidities 1
• Geriatric psychiatrists often diagnose dementia, particularly when behavioral or psychiatric symptoms are prominent 3
• Psychiatrists play a significant role in dementia diagnosis, with one survey showing they personally diagnose approximately two-thirds (67%) of their patients with mild cognitive impairment (MCI) or mild Alzheimer's disease 3

Multidisciplinary Approach

• The VA guidelines specifically address the importance of a multidisciplinary team approach for accurate differential diagnosis of dementia 1
• Referral to specialists (neuropsychologists, neurologists, psychiatrists, or geriatricians) is recommended by most guidelines for differential diagnosis 1
• Neuropsychologists provide detailed cognitive testing when the diagnosis remains unclear after initial assessment 1

Diagnostic Process

• Diagnosis requires a combination of history-taking from both the patient and a knowledgeable informant 1
• Objective cognitive assessment through bedside mental status examination or formal neuropsychological testing is essential 1
• Laboratory tests to rule out reversible causes of cognitive impairment are recommended by all guidelines 1
• Neuroimaging (CT or MRI) is commonly used to exclude other causes of cognitive symptoms 1

Referral Patterns

• Only about 18.4% of patients who screen positive for dementia in primary care are referred to neurology or psychiatry specialists 2
• Younger patients and those with greater functional impairment are more likely to be referred to specialists 2
• Comorbid depression is a common reason for referral to psychiatrists or neuropsychologists 1

Emerging Trends in Diagnosis

• With the approval of disease-modifying treatments for Alzheimer's disease, biomarker testing (including blood biomarkers, CSF analysis, and amyloid PET) is becoming increasingly important in the diagnostic process 1
• The shortage of dementia specialists is a growing concern as the population ages, with the demand for neurologists projected to exceed supply in all regions of the USA by 2025 1

Diagnostic Accuracy Concerns

• Studies suggest that 31-74% of patients with symptomatic Alzheimer's disease are not identified in primary care settings 1
• Even when evaluated by dementia specialists, the etiological diagnosis changed in 36% of patients following amyloid PET scanning 1
• Different subspecialties show significant variations in their approach to dementia evaluation and treatment 4