Alzheimer's disease: Issues and challenges in primary care

The challenge in primary care practice is identifying persons with symptoms of Alzheimer's Disease (AD) who often have limited capacity to recognize their own symptoms and attribute cognitive decline to chronic illness or aging. Brief office visit communications without an informant, such as a spouse or adult child rarely uncover mild stage AD. Clinicians in primary care fail to screen older adults for AD on a routine basis because of insufficient time, inadequate reimbursement for services, and uncertainty about die value of an early diagnosis. Although current pharmacologic and behavioral interventions and patient education do not prevent eventual disease progression, they arguably lead to improvements in understanding, self-efficacy, and quality of life for the patient and family.