Recognition and assessment of dementia in primary care

The majority of community nurses will come into contact with people with dementia in their everyday practice. They will have caseloads that are probably dominated by patients with multiple comorbidities, such as diabetes, cardiovascular disease, cerebrovascular disease (especially stroke), frailty, arthritis in all its forms, wounds and conditions requiring palliative care (Olver and Buckingham, 1997; McCrory, 2019). Although many of these conditions are strongly associated with cognitive impairment (Sandylian and Dening, 2019), dementia may be overshadowed by the severity of these conditions. Such overshadowing matters, because community nurses work with large caseloads, often focusing on a specific problem, and cases are mainly demand-led. Therefore, community nurses tend to be reactive care providers (Stuart et al, 2008; McCrory, 2019). Catching hidden dementia may be difficult because other problems, such as a leg ulcer that will not heal, disabling chronic obstructive pulmonary disease or poorly controlled urinary incontinence, are the more visible conditions, are more disabling and demanding, and thus are the targets of the nurse. Thus, the overshadowing of the dementia would make sense (Iliffe, 2019). Similarly, from the patient's point of view, their painful swollen leg, shortness of breath on the slightest of exertion or problems managing their incontinence may be much more significant than their memory loss, muddled thinking or inability to use the TV remote control.