A random 20% sample of 4,007,351 Medicare beneficiaries 67+ years in 2008 or 2009. The sample is enrolled in fee-for-service Medicare for ≥ 2 years without a previous dementia diagnosis. Total sample size  was 226,604 with incident dementia diagnosis in 2008 or 2009. Health care claims were examined for up to 5 years after diagnosis or until death. The main outcomes studied were percent population with incident diagnosis of dementia, distribution of specialty of diagnosing physician, percent of beneficiaries with post diagnostic visit with a dementia specialist by 1 and 5 years after diagnosis, distribution of dementia subtype diagnosis, and change in diagnosis over time and by physician specialty. The key findings are:

• 85% of beneficiaries were diagnosed by non-dementia specialists
• follow up care with a dementia specialist was not common 1 year post diagnosis (27%) and increased to just above one-third (36.2%) of the total sample size by 5 years
• Hispanics and Asians are less likely to receive care from a dementia specialist than whites and blacks
• diagnosis with dementia subtypes  as “unspecified dementia” was common with one-quarter (23.8%) of beneficiaries retaining this diagnosis at 5 years – this rate was lower (16%) among beneficiaries with dementia specialist health care
• over 5 years < 50% of beneficiaries with dementia received an AD diagnosis, higher among those with a dementia specialist care visit (49.6%) than nonspecialist (41%)

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