Recognizing dementia in the clinic: whom to suspect, whom to test

Dementia-particularly that due to Alzheimer's disease-affects millions of Americans, costs society billions of dollars, and takes an incalculable toll on human lives. Despite these staggering statistics, dementia is still frequently unrecognized in clinical settings. While several rationales are employed to justify this failure to diagnose dementia, there are as many important reasons to diagnose the syndrome. Unrecognized dementia puts patients at risk for numerous complications, including medication errors, fragmented health care, and delirium. Unrecognized dementia can lead patients to financial disaster; accidents on the road, in the home, and at work; and unnecessary interpersonal conflicts and alienation from family and friends. Patients are robbed of their chance to plan for healthier and happier futures and to perhaps contribute meaningfully to our understanding of these dreadful diseases. Recognizing progressive dementia should be a priority for all health care providers dealing with the elderly.