Usually, the GP refers those he/she suspects that have dementia to a specialist (psychiatrist, neurologist, or geriatrician) under secondary care, but may opt to conduct neuropsychological tests, as well as ask for the blood tests and tomography directly if possible.

Yes. Although specialists in the public sector (i.e., Hospital Authority) are the main providers of diagnostic services in Hong Kong, there are available diagnostic services in primary care in the private sector:

1. Primary care physicians with specialist qualifications are able to provide diagnosis. By the end of 2016, there are 118 specialists registered under neurology and 355 specialists registered under psychiatry in Hong Kong (The Medical Council of Hong Kong, 2016). Some of these specialists work in primary care settings but the exact number is unknown.
2. Some primary care physicians receive dementia training. For example, in year 2016/2017, 132 and 51 physicians have successfully completed basic and advanced courses for doctors in dementia provided by the Hong Kong Alzheimer’s Disease Association. 480 people with suspected dementia have received diagnostic service under the Early Detection Service of Hong Kong Alzheimer’s Disease Association (Hong Kong Alzheimer’s Disease Association, 2017).

References:

Hong Kong Alzheimer’s Disease Association. (2017). 2016/17 Annual Report. Retrieved from https://87bdf434-9adb-480e-b8f9-9239b0ceb722.filesusr.com/ugd/85d328_b73ba35a8c0b45f2ac5e26a9f18050ca.pdf

The Medical Council of Hong Kong. (2016). Annual Report 2016. Retrieved from https://www.mchk.org.hk/files/annual/files/2016/MCAR_2016_e.pdf

Generally, a GP refers the person to a specialist (neurologist/psychiatrist).

PERDOSSI has developed a diagnostic protocol for primary care. In addition, from 2019 onwards primary care centres have to adopt a screening approach by the Ministry of Health’s regulation no. 4/2019 on Minimum Standard of Service. The document states that all people aged 60 years old or above should receive an annual check of blood glucose and cholesterol level, Geriatric Depression Scale, Abbreviated Mental Test, Instrumental Activities of Daily Living (Ministry of Health Regulation No. 4/2019 on Technical Standard to Fulfill Quality of Basic Service in Minimum Standard of Healthcare Service (Permenkes No. 4/2019 Tentang Standar Teknis Pemenuhan Mutu Pelayanan Dasar Pada Standar Pelayanan Minimal Bidang, 2019).

References:

Ministry of Health Regulation no. 4/2019 on Technical Standard to Fulfill Quality of Basic Service in Minimum Standard of Healthcare Service (Permenkes no. 4/2019 tentang Standar Teknis Pemenuhan Mutu Pelayanan Dasar pada Standar Pelayanan Minimal Bidang). (2019). (Testimony of Ministry of Health Republic of Indonesia).

Please refer to item 07.01.01.

Diagnosis for dementia is made by a medical officer at referral county hospitals, but as a secondary condition. Often, diagnosis is received late, following admission to inpatient care diagnosis because the primary complaint at the outpatient clinic is dementia unrelated and the dementia symptoms are mostly identified during inpatient care (Musyimi et al., 2019).

References:

Musyimi, C., Mutunga, E., & Ndetei, D. (2019). Stigma and dementia care in Kenya: Strengthening Responses to Dementia in Developing Countries (STRiDE) Project. In World Alzheimer Report 2019: Attitudes to dementia (pp. 121–122). London, UK: Alzheimer’s Disease International. https://www.alzint.org/u/WorldAlzheimerReport2019.pdf

Not as part of any public health or social security institutions. Most people with a diagnosis obtains it from private services/specialists.

While there are no specific diagnostic services per se in primary care, there is an expectation that primary care is the first point of contact for the assessment of cognitive impairment and that they will be able to assess and manage most uncomplicated dementias. All primary care practitioners have access to the regional dementia pathways which outline the process of assessment and management of dementia, as well as the threshold for referral to secondary or specialist services.

There is a lack of dementia and geriatric specialists in South Africa (see Part 2). Pathways to diagnosis in the public sector are confounded by a lack of understanding and misconceptions of dementia among PHC workers (Kalula et al., 2010; Kalula & Petros, 2011); as well as beliefs that dementia is a natural part of aging without being referred for further investigation, treatment and care. Diagnostic services in the private sector are usually obtained via general practitioners, where persons with suspected dementia seek advice via their family practitioners (Vally, 2010).

References:

Kalula, S. Z., & Petros, G. (2011). Responses to Dementia in Less Developed Countries with a focus on South Africa. Global Aging, 7(1), 31–40.

Kalula, S. Z., Ferreira, M., Thomas, K. G. F., De Villiers, L., Joska, J. A., & Geffen, L. N. (2010). Profile and management of patients at a memory clinic. South African Medical Journal, 100(7), 449. https://doi.org/10.7196/SAMJ.3384

Vally, Z. (2010). The assessment and management of dementia. South African Family Practice, 52(5), 392–395. https://doi.org/10.1080/20786204.2010.10874014