This chapter covers a selection of tools and resources for dementia diagnosis and management in primary care based on the experience of a community-based dementia early detection service, for use by trained allied health and social care professionals and primary care physicians to promote communication across disciplines. Considering the large and growing number of validated tools available for outcome assessment and detection of dementia, our goal here is to share useful materials for quick reference rather than a comprehensive summary of available tools and resources. Readers will find in this chapter a sample form to facilitate history-taking, with an explanation of the needed information and recommended use of the General Practitioner Assessment of Cognition (GPCOG); a quick overview of the clinical features suggestive of non-Alzheimer’s disease; a checklist for physical examination and investigation; a sample cognitive and functioning report of an early intervention service with an explanation of the important information to include; common spontaneously reported symptoms in an early intervention service; and lists of useful resources, infographics, and educational material for explaining dementia diagnosis and management.

Readers are presented with 19 case examples of atypical Alzheimer’s disease, other dementias, and conditions resembling dementia. Each case comes with a summary of cognitive and functional assessment results, complaints by informants, clinical history, laboratory examinations indicated, diagnosis, and management, followed by insights from both medical and psychosocial perspectives. These are organised around the following themes: cases illustrative of when imaging and further observation are needed; cases that may be referred to as ‘pseudodementia’, and cases where a decision to refer on may be needed.

In this chapter, readers are provided with 80 case examples of typical Alzheimer’s disease. Each case comes with a summary of cognitive and functional assessment results, complaints by informants, clinical history, laboratory examinations indicated, diagnosis, and management, followed by insights from both medical and psychosocial perspectives. These are organised around several themes: cases illustrative of pathognomonic features of Alzheimer’s disease; cases that are relevant for understanding cognitive, functioning, and clinical assessment findings; cases highlighting indications for further investigations; cases presenting with carers’ complaints about challenging behaviours; and cases in which the line between normal ageing, mild cognitive impairment, and mild dementia seems unclear.

Alzheimer’s Disease International highlighted in 2016 the role of primary care in dementia. With overly specialised healthcare systems and stretched specialist workforce, dementia is currently under-diagnosed and under-managed. While various service models have been trialled in different parts of the world, several barriers remain; among them are a lack of a gatekeeping role for primary care in highly stretched healthcare systems and a perception that primary care is of a lower quality. In this chapter, we briefly review and outline the possible roles of primary care, including the gatekeeping role, based on the concepts and practices of task-shifting and task-sharing in dementia care. Examples of primary care models in dementia are given, followed by a basic overview of the work-up, diagnosis, and management related to simple, uncomplicated Alzheimer’s disease in line with gatekeeping and task-shifting/sharing. With this background, we then move on to the rationales and evidence of integrated health and social care services, with an example of community primary care-based integrated health and social care services, from which the cases provided in this book were drawn.

This is a summary of the lessons learned from the 99 cases presented in this book. We have covered issues related to advance care planning, carer stress in different case scenarios and the support needed, practical tips about disclosing a dementia diagnosis, issues surrounding management, home safety, and a dementia-friendly community – all from a primary care team perspective. References to cases are provided to promote knowledge integration and future application. Detailed rationales for some of the recommended actions in the cases will be provided, such as current evidence and clinical guidance on pharmacological and non-pharmacological interventions, the prevalence of certain symptoms, the expected illness trajectory, the estimation of cognitive reserve, and the life course perspective of understanding dementia that is of particular relevance in primary care.