Longitudinal analysis of dementia diagnosis and specialty care among racially diverse Medicare beneficiaries
Open accessAbstract
Introduction: There is insufficient understanding of diagnosis of etiologic dementia subtypes and contact with specialized dementia care among older Americans. Methods: We quantified dementia diagnoses and subsequent health care over five years by etiologic subtype and physician specialty among Medicare beneficiaries with incident dementia diagnosis in 2008/09 (226,604 persons/714,015 person‐years). Results: Eighty‐five percent of people were diagnosed by a nondementia specialist physician. Use of dementia specialists within one year (22%) and five years (36%) of diagnosis was low. “Unspecified” dementia diagnosis was common, higher among those diagnosed by nondementia specialists (33.2%) than dementia specialists (21.6%). Half of diagnoses were Alzheimer's disease. Discussion: Ascertainment of etiologic dementia subtype may inform hereditary risk and facilitate financial and care planning. Use of dementia specialty care was low, particularly for Hispanics and Asians, and associated with more detection of etiological subtype. Dementia‐related professional development for nonspecialists is urgent given their central role in dementia diagnosis and care.
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Of those diagnosed by a specialist, 44% were diagnosed by a neurologist, 34% by a psychiatrist and 22% by a geriatrician.
“Of those diagnosed by a specialist, 44% were diagnosed by a neurologist, 34% by a psychiatrist and 22% by a geriatrician.”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [628]
The Results section (“Distribution of Physician Specialty”) supports the 44% figure for neurologists. It reports 47.4% for psychiatrists and related specialties and 8.6% for geriatricians, not 34% and 22%. (LLM, conf=0.93)
Experimental — accuracy not yet measuredOne study of Medicare beneficiaries found that 85% of those diagnosed with dementia were initially diagnosed by a clinician other than a dementia specialist, and 15% by a specialist.
“One study of Medicare beneficiaries found that 85% of those diagnosed with dementia were initially diagnosed by a clinician other than a dementia specialist (e.g., a PCP, emergency medicine physician or nurse practitioner), and the remaining 15% by a specialist.628”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [628]
The Results (Distribution of Physician Specialty) report that 84.6% of diagnosed Medicare beneficiaries were initially diagnosed by a non-dementia specialist physician, supporting the rounded 85% and the remaining approximately 15%. The same section identifies internal medicine and family practice physicians among non-specialists, but our copy does not identify emergency medicine physicians or nurse practitioners as examples of initial diagnosing clinicians. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA study of Medicare beneficiaries found that 85% of people living with dementia were diagnosed by providers who do not specialize in dementia.
“A study of Medicare beneficiaries found that 85% of people living with dementia were diagnosed by providers who do not specialize in dementia (e.g., PCP, emergency medicine physician, nurse practitioner, clinical psychologist).”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [706]
The Results (Distribution of Physician Specialty) report that 84.6% of diagnosed Medicare beneficiaries were initially diagnosed by a non-dementia specialist physician, supporting the rounded 85% figure. The paper identifies internal medicine and family practice physicians among these non-specialists, but the cited passages do not establish the sentence’s other examples—emergency medicine physicians, nurse practitioners, or clinical psychologists—as diagnosing providers in that group. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAmong the remaining 15% diagnosed by a provider who specializes in dementia, 47% were diagnosed by a psychiatrist, 44% by a neurologist and 9% by a geriatrician.
“Among the remaining 15% diagnosed by a provider who specializes in dementia, 47% were diagnosed by a psychiatrist, including geriatric psychiatrists and neuropsychiatrists, 44% by a neurologist and 9% by a geriatrician.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [706]
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- Authors
- Drabo, E. F., Barthold, D., Joyce, G., Ferido, P., Chang Chui, H., & Zissimopoulos, J.
- Affiliations
- Johns Hopkins University (US)
- University of Washington (US)
- University of Southern California (US)
- Keck School of Medicine, University of Southern California Los Angeles CA USA
- Corresponding author
- Zissimopoulos, Julie
- Venue
- Alzheimer's & Dementia
- Publisher
- Wiley
- Published
- 2019-09-04
- Volume
- 15
- Issue
- 11
- Pages
- 1402-1411
- ISSN
- 1552-5260 (ISSN-L)
- 1552-5279
- PMC
- PMC6874742
- OpenAlex
- W2972048113
- Cited by
- 155
- References
- 50
- Citations by year
- 2026: 29 · 2025: 33 · 2024: 43 · 2023: 17 · 2022: 15 · 2021: 11 · 2020: 6 · 2018: 1
- FWCI
- 6.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Alzheimer s & Dementia (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R01AG055401, P30AG043073, R01HL126804)
- National Heart, Lung, and Blood Institute (R01HL130462)
- University of Southern California (1R34AG049652)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- dementia diagnosis
- MeSH terms
- Aged, Aged, 80 and over, Dementia, Ethnicity, Female, Medicare, Humans, Physicians, Family, Psychiatry, Specialization, United States
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