Office screening for dementia.

mediciNe & HealtH/RHode islaNd dementia is a Common affliCtion in late life, affecting over 10% of US adults 65 and older, with prevalence doubling each five years of age thereafter. Dementia often goes unnoticed by primary care providers for several years after its onset. Not until sufficiently severe impairment such as difficulty with instrumental activities of daily living, including keeping appointments, impulsive purchasing, or getting lost driving prompts a caregiver to schedule a clinical visit or cognitive slip at the clinical encounter will the clinician realize a need to more carefully assess the patient. A public health threat with significant implications for patients, families and caregivers, dementia also produces a risk for increased health care utilization, including home health, nursing home and hospitalization; and, elder neglect and abuse. Those with mild cognitive impairment (MCI), but not dementia, incur a three to eightfold increased risk for ensuing dementia, depending on the definition used for MCI. Earlier recognition of MCI and dementia can help patients and those who care for them better prepare for later disability, and perhaps intervene to slow cognitive decline and keep patients and others safe. However, early recognition of cognitive impairment can only succeed if it is systematically implemented into clinical practice, a challenge for any busy primary care physician.