Differences between clinical subspecialties in the outpatient evaluation and treatment of dementia in an academic medical center.

BACKGROUND: Professional organizations have recommended guidelines for the optimal investigation and management of dementia. It is unknown whether physicians from different subspecialties investigate and treat dementia in the same manner or according to these guidelines.

METHODS: We screened 1,401 charts of patients who were seen in neurology, mental health, geropsychiatry and geriatrics clinics. The charts of 410 patients who were diagnosed with dementia were reviewed in detail to determine how they were evaluated and managed.

RESULTS: Overall, 40% of patients received a complete laboratory workup to rule out comorbidities, 70% of patients received neuroimaging with either computerized tomography or magnetic resonance imaging of the brain, 63% had a depression screen and 38% of patients underwent neuropsychological testing. However, the frequency with which they were obtained differed significantly across clinics (p < 0.05). The frequency with which acetylcholinesterase inhibitors (CHEIs) were used did not differ significantly (p = 0.07) for patients with Alzheimer's disease (AD), but differed significantly (p < 0.05) for dementia categories where CHEIs are thought to be useful (AD, vascular dementia and dementia with Lewy bodies).

CONCLUSIONS: There were significant differences between subspecialties in the evaluation and treatment of dementia. It will be important to investigate whether these differences alter patient outcomes.