The case of dementia: psychiatry or neurology?

The case of dementia: psychiatry or neurology?Although the traditional biomedical disease model has often been criticized in psychiatry, few have questioned its relevance for the dementias, probably because some time ago these disorders were suggested as having organic aetiologies which call for pathogenetic biochemical and physiological theories.The progress of a disease such as Alzheimers' re¯ects the classical course of a degenerating brain disease.Considering the importance of cardiovascular aetiologies for other dementias it is hardly surprising that the dementias have been claimed as belonging primarily to neurology, leaving the role of psychiatrists to treat psychotic symptoms and gross behavioural disturbances.Among the reasons for this viewpoint is the frequent use of neuroimaging techniques (MR-, SPECT-, PET-scanning) to classify the dementias and to delineate pathophysiological mechanisms.The strength of the biomedical model hardly needs further comment.It represents a compehensive approach to disease phenomena including thorough psychopathological characterization and classi®cation by standardized clinical assessments, epidemiological studies and the elucidation of aetiology in terms of gene±environment interaction and extensive characterization of pathology in terms of anatomy, genetics and biochemistry.Despite progress in neurobiology and medical imaging technology the diagnosis of dementia still depends primarily on classical psychopathological analysis of current and past symptomatology.It is reassuring that the study by Lolk et al. published in this issue (1) suggests the CAMCOG (Cambridge Cognitive Examination) as a sensitive and speci®c scale for diagnosing very mild and mild dementia.This is an example of the advantage of applying strict empirical methods in psychopathology.Diagnosing dementia at an early stage is of great importance, as pharmacological treatment of cognitive symptoms of dementia is now possible.The success of the biomedical model for our conception of dementia has no competition.