This book has hopefully demonstrated that neurologists are not redundant in the diagnosis and management of people with cognitive disorders, indeed have a valuable if circumscribed role to play. This clinical role may also facilitate research studies. However, it is not, and never was, the purpose of this book to be a merely factional account, a case of special pleading for the retention of neurology-led dementia clinics.

Whatever misgivings a neurologist may have about the National Dementia Strategy (NDS) for England (Department of Health 2008, 2009; Larner 2009), not least the anticipated changes in quality of life based on data from a single, 6-month, uncontrolled study (Banerjee et al. 2007), nevertheless the NDS authors were entirely correct to characterise their publications with the indefinite article (“a National Dementia Strategy”; (Department of Health 2008, 2009)) rather than the definite article (although it has de facto become “the National Dementia Strategy”). Wittingly or not, this indicated that many other National Dementia Strategies were and are possible. For example, one approach might be a campaign of vigorous primary and secondary prevention of dementia, by screening the whole adult population for recognised risk factors for dementia (e.g. vascular risk factors, especially hypertension; Patterson et al. 2008). Predicting dementia risk in 20 years time, based on factors such as age, education, blood pressure, cholesterol and obesity (Kivipelto et al. 2006), might be an appropriate public health strategy, emphasizing a life-long, lifestyle approach to cognitive well-being. Whether this would indeed prevent cases is, however, uncertain (e.g. Peters et al. 2008).

With the predictions of a dramatic increase in the number of dementia sufferers in the coming decades (e.g. Ferri et al. 2005; Alzheimer’s Society 2007), another national dementia strategy might be to develop a dementia specialty per se, transcending current professional boundaries between neurology, psychiatry, geriatrics, etc. The skills required to diagnose and manage the dementia syndrome effectively require elements from all these disciplines, and potentially others as well (e.g. clinical genetics, palliative care). If management of the dementia care pathway from diagnosis to end-of-life care via a “single point of referral” for all cases (National Institute for Health and Clinical Excellence/Social Care Institute for Excellence 2006) is a legitimate goal, then specific training in dementia would seem to be legitimate, with all the implications of developing a faculty, training programmes and certification to assure specific standards are met. The admixture of skills required for such a dementia specialist would perhaps make this a potentially attractive discipline to trainees.