Management Issues in Primary Care

Dementia is an important public health problem, though more than half of all dementia cases may go undiagnosed in primary-care settings.1 Screening is one strategy to increase detection and diagnosis of dementia in primary care, but only 24% of Canadian primary-care physicians routinely screen for dementia.2 Multiple barriers to screening have been identified, the most ubiquitous being “tyranny of the urgent.” Most primary care physicians identify difficulty implementing routine screening into a feefor-service office visit. Screening for dementia has additional challenges in that people with dementia may not recognize or mention deficits, or may ascribe cognitive changes to normal aging. Family members may notice deficits but often do not accompany the affected individual to appointments. Finally, physicians who are skeptical about the benefits of treatment for dementia may not perceive benefit to early diagnosis and may believe that some patients could be harmed.3 Such barriers are important considerations when planning implementation of a screening program, however, application of the World Health Organization (WHO) criteria4 for optimal screening conditions (Table 1) for use in screening for dementia in primary care reveals that challenges extend beyond practical considerations to more fundamental issues.