title: The UK experience of promoting dementia recognition and management in primary care.
abstract: BACKGROUND
  The early and timely recognition of dementia syndrome is a policy imperative in many countries. In the UK the achievement of earlier and timelier recognition has been pursued through educational interventions, incentivisation of general practitioners and the promotion of a network of memory clinics.
  
  
  OBJECTIVE
  The effectiveness of education, incentivisation and memory clinic activity are unknown. This article analyses data from different sources to evaluate the impact of these interventions on the incidence and prevalence of dementia, and the diagnostic performance of memory clinics.
  
  
  METHODS
  Three data sources were used: 1) aggregated, anonymised data from a network of general practices using the same electronic medical record software, The Health Information Network (THIN), 2) UK Health & Social Care Information Centre data reports and 3) Responses to Freedom of Information Act requests.
  
  
  RESULTS
  Educational interventions did not appear to change the recorded incidence of dementia syndrome. There was no apparent effect of education, incentives or memory clinic activity on the reported incidence of dementia syndrome between 1997 and 2011 but there were signs of change in the documentation of consultations with people with dementia. There was no clear impact of incentivisation and memory clinic activity in prevalence data. Memory clinics are seeing more patients but fewer are being diagnosed with dementia.
  
  
  CONCLUSIONS
  It is not clear why there has been no upturn in documented incidence or prevalence of dementia syndrome despite substantial efforts and this requires further investigation to guide policy changes. The performance of memory clinics also needs further study.
authors.affiliation: University College London, Gower Street, WC1E 6BT, London, UK. s.iliffe@ucl.ac.uk.
authors.forename: Steve
authors.identifier: http://orcid.org/0000-0003-2806-3997
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: University College London, Gower Street, WC1E 6BT, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wilcock
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005858:Germany; D006293:Health Promotion / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D015994:Incidence; D007318:Inservice Training / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D010346:Patient Care Management / Q000706:statistics & numerical data / Q000639:trends; D058007:Physicians, Primary Care / Q000706:statistics & numerical data* / Q000639:trends; D011320:Primary Health Care / Q000706:statistics & numerical data* / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology; D014600:Utilization Review
keywords: Dementia; Early diagnosis; Education; Financial incentives; Memory clinics