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<p>Dementia encompasses a variety of neurodegenerative disorders, including prion disease, Alzheimer’s disease (AD), vascular dementia (VaD), frontotemporal dementia (FTD), and α-synucleinopathies, each characterized by distinct risk factors, clinical presentations, and management strategies. As dementia progresses, individuals require progressively greater supervision and support with decision-making and may ultimately need full-time long-term care. Globally, the prevalence of dementia is estimated at approximately 5%, with rates increasing markedly with advancing age. In the United States, the prevalence of Alzheimer’s dementia among adults aged 65 years and older is approximately 11% (1 in 9), rising to 33.4% among individuals aged 85 years and older. Primary care physicians (PCPs) are often the first healthcare professionals to encounter patients presenting with symptoms of cognitive decline; therefore, maintaining a high index of clinical suspicion is essential to avoid delays in diagnosis and care. Through recognition of risk factors and the performance of thorough clinical and physical examinations, PCPs can identify dementia at earlier stages, potentially alleviating symptoms and reducing overall disease burden. Evidence suggests that reliance on clinical judgment alone in primary care has limited diagnostic sensitivity for dementia; however, the FDA clearance of blood-based biomarkers presents an opportunity for PCPs to integrate these tools into practice, substantially improving diagnostic accuracy. This advancement underscores the critical and expanding role of PCPs in identifying individuals earlier in the disease course and facilitating timely intervention. Early detection is integral to family counseling, assessment of potentially reversible etiologies, advanced care planning, goal-directed therapy discussions, caregiver support, and eligibility for emerging disease-modifying therapies (DMTs). Despite this central role, PCPs face significant challenges, including heterogeneous symptom presentations, limited access to diagnostic resources, and limited disease-modifying therapies. This narrative review synthesizes current evidence with a primary care-oriented lens, emphasizing practical, actionable strategies feasible in U.S. settings, including underserved and rural areas where PCPs may be the sole point of contact. Within primary care, core responsibilities include recognizing cognitive symptoms, evaluating reversible causes, initiating brief cognitive assessment, counseling families, and referring patients for specialist confirmation or advanced therapies when appropriate. Ongoing advances in medical research and biotechnology offer promising opportunities to enhance early diagnosis and expand treatment options. By serving as diagnosticians, care coordinators, and treatment initiators within their scope, PCPs can improve quality of life for patients and caregivers while reducing the broader burden of dementia.</p>

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The Role of Primary Care Physicians in Early Diagnosis and Management of Dementia: A Narrative Review for Clinical Practice

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Kaitlyn Alessi,
  • Charles Sarria,
  • Nehabahen Chauhan,
  • Naushira Pandya,
  • Mayur S. Parmar

摘要

Dementia encompasses a variety of neurodegenerative disorders, including prion disease, Alzheimer’s disease (AD), vascular dementia (VaD), frontotemporal dementia (FTD), and α-synucleinopathies, each characterized by distinct risk factors, clinical presentations, and management strategies. As dementia progresses, individuals require progressively greater supervision and support with decision-making and may ultimately need full-time long-term care. Globally, the prevalence of dementia is estimated at approximately 5%, with rates increasing markedly with advancing age. In the United States, the prevalence of Alzheimer’s dementia among adults aged 65 years and older is approximately 11% (1 in 9), rising to 33.4% among individuals aged 85 years and older. Primary care physicians (PCPs) are often the first healthcare professionals to encounter patients presenting with symptoms of cognitive decline; therefore, maintaining a high index of clinical suspicion is essential to avoid delays in diagnosis and care. Through recognition of risk factors and the performance of thorough clinical and physical examinations, PCPs can identify dementia at earlier stages, potentially alleviating symptoms and reducing overall disease burden. Evidence suggests that reliance on clinical judgment alone in primary care has limited diagnostic sensitivity for dementia; however, the FDA clearance of blood-based biomarkers presents an opportunity for PCPs to integrate these tools into practice, substantially improving diagnostic accuracy. This advancement underscores the critical and expanding role of PCPs in identifying individuals earlier in the disease course and facilitating timely intervention. Early detection is integral to family counseling, assessment of potentially reversible etiologies, advanced care planning, goal-directed therapy discussions, caregiver support, and eligibility for emerging disease-modifying therapies (DMTs). Despite this central role, PCPs face significant challenges, including heterogeneous symptom presentations, limited access to diagnostic resources, and limited disease-modifying therapies. This narrative review synthesizes current evidence with a primary care-oriented lens, emphasizing practical, actionable strategies feasible in U.S. settings, including underserved and rural areas where PCPs may be the sole point of contact. Within primary care, core responsibilities include recognizing cognitive symptoms, evaluating reversible causes, initiating brief cognitive assessment, counseling families, and referring patients for specialist confirmation or advanced therapies when appropriate. Ongoing advances in medical research and biotechnology offer promising opportunities to enhance early diagnosis and expand treatment options. By serving as diagnosticians, care coordinators, and treatment initiators within their scope, PCPs can improve quality of life for patients and caregivers while reducing the broader burden of dementia.