OBJECTIVES:To explore the extent of variation in the detection of dementia in primary care across Europe, and the potential for the development of European guidelines.METHOD:A mixture of focus group and adapted nominal group methods involving 23 experts of different disciplines and from eight European countries.RESULTS:The diagnosis of dementia should be 'timely' rather than 'early'. Timeliness has an impact on the patient, on the caregiver, on healthcare professionals, and on society. Ethical and moral issues may interfere with the aim of timely diagnosis. Guidelines may be important for facilitating a timely diagnosis of dementia, but were infrequently used and not even available in three of the eight countries. Referral pathways often depended on health care system characteristics, differing throughout the eight European countries, whilst diagnostic strategies differed due to varied cultural influences. There was consensus that national variations can be reduced and timely diagnosis enhanced by combining simple tests using a systematic stepwise case-finding strategy, in conjunction with a strong infrastructure of multidisciplinary collaboration.CONCLUSIONS:This study identified three key themes that should be considered in harmonizing European approaches to the diagnosis of dementia in primary care: (1) a focus on timely diagnosis, (2) the need for the development and implementation of guidelines, and (3) the identification of appropriate referral pathways and diagnostic strategies including multi-professional collaboration. The content of guidelines may be determined by the perspectives of the guideline developers.

Adequate diagnostic information can be considered a basic intervention in dementia care. However, clear diagnostic disclosure in dementia is not yet regular practice and the evidence regarding patients' preferences for or against disclosure is scarce. The aim of this study was to give an in-depth description of the impact of receiving the diagnosis of dementia, both on patients and the patients' proxies. The method used was the design of a grounded theory interview study. Analysis of the interviews revealed that disclosure had an impact on three key domains: awareness of dementia, partnership, and social relationships. Most patients and carers reported that they had experienced the disclosure of the diagnosis as a confirmation of their assumptions. A minority of patients and carers felt threatened and shocked by the diagnosis, because they did not expect it. The findings of this analysis challenge current opinions and practice about diagnostic disclosure like obstacles anticipated by clinicians such as inducing negative feelings and causing harm. Disclosure of the diagnosis of dementia can generally be carried out without introducing stress for the patient or carer and facilitates guidance. Therefore regular practice should include the careful planning and performance of diagnostic disclosure.

In this study we investigated whether a support program based on the model of the Amsterdam meeting centers for people with dementia and their carers, is in line with the needs and possibilities in other areas in the Netherlands, or if variations in the program are indicated. This study is part of a larger study into the nationwide implementation of meeting centers in the Netherlands. The data gathered on the basis of questionnaires shows that, although the support offer is almost identical on the interregional level, there are differences in terms of initiator(s), type of location, frequency of discussion groups and monthly meeting for all participants, background of staff members, number of volunteers and structural funding. The people with dementia who use the meeting centers in the various regions do not differ significantly on sex, age, civil status, severity of dementia and physical invalidity. The family carers also exhibit more similarities than differences on the interregional level. In every region the majority of carers are female, married or cohabiting, and a minority are gainfully employed.They generally share a household with the person with dementia, or they live in the same municipality. In nearly all centers the majority of carers exhibit psychological and/or psychosomatic symptoms. In most regions participants make use of all elements of the support program (social club, discussion groups, informative meetings, consultation hour). The study shows that the support program based on the Amsterdam model meets general needs of people with dementia and their carers and is therefore generally applicable, but adaptive implementation is desirable.