Primary care physicians are in the key position for early recognition and management of memory disorders. The study investigates their competence for this task longitudinally.

Written case vignettes on slight memory disorders (case 1) and moderate dementia (case 2) were presented to primary care physicians in their practices in 1993 and 2001. A standardised open interview was performed and the psychosocial focus remained secret.

Both studies were representative with response rates of 82.1% (n=145) and 71.8% (n=122). From 1993 to 2001 the rate of dementia diagnoses increased and those of vascular encephalopathy/organic brain disease decreased significantly. However, overall rates for diagnosis of Alzheimer dementia remained at about 25% for primary and 50% for differential diagnostic considerations. Vascular diagnoses kept dominating. The diagnostic tools showed a significant increase of the use of neuropsychological screening tests and of thyroid screen in moderate dementia. Neuroimaging would be applied significantly by significantly less physicians (<20%). Antidementia drug prescriptions decreased dramatically mainly regarding the conventional nootropics. Cholinesterase Inhibitors would be prescribed by less than 10% of the physicians. However, knowledge on psychosocial help increased significantly.

Competence changes over time can be investigated with this method. Primary care physicians' competence remains too low without systematic training. Especially Alzheimer's dementia will not be early recognized and adequate treated.