It is a truth universally acknowledged that dementia is now a major global public health issue, set to increase as the world population ages (Ferri et al. 2005). In 2010, a global cost of illness study suggested a “base case option” figure of US$604 billion, equivalent to the 18th largest national economy in the world (between Turkey and Indonesia), and larger than the revenue of the world’s largest companies (Wal-Mart, Exxon Mobil). In high income countries, which accounted for 89 % of the costs but only 46 % of dementia prevalence, this is mostly due to direct costs of social care, whilst in low and middle income countries, which accounted for only 11 % of the costs but 54 % of dementia prevalence, this is mostly due to informal care costs (Wimo and Prince 2010). The need to address these issues is obvious, from the human as well as the economic standpoint, and will require governments to make dementia a priority, with the development of policies, investment in chronic care, and funding of research.

Faced with such enormities, what can the individual clinician hope to contribute? The National Dementia Strategy (NDS) for England (Department of Health 2009) proposed three key themes to address the problem of dementia: improved awareness, early diagnosis and intervention, and a higher quality of care. Many of the 17 “key objectives” fell outwith the clinical domain, such as an information campaign to raise awareness and reduce stigma, and improvement in community personal support services, housing support and care homes. However, the early identification and appropriate initial management of dementia cases may be deemed to fall squarely within the remit of the individual clinician. The first issue to address, therefore, is the referral routes by which such patients arrive at the clinical encounter.