Barriers to Early Dementia Diagnosis in Primary Care: A Literature Review

BACKGROUND
Early dementia diagnosis brings significant benefits - enabling patients and families to plan ahead, access support services, begin appropriate disease management, and potentially participate in clinical trials.[1] In the UK, the majority of patients with cognitive concerns first present to their general practitioner (GP). Despite national efforts to improve early detection, NHS England data from 2024 indicate that only around 65% of people aged 65 and over estimated to have dementia had a formally recorded diagnosis,[2] suggesting a persistent diagnostic gap.
Timely diagnosis is particularly important given the estimated 900,000 people currently living with dementia in the UK, a figure projected to rise sharply as the population ages.[2] This literature review examines the evidence on what impedes early recognition of dementia in primary care.

METHODS
A structured search of PubMed, MEDLINE, and Google Scholar was conducted using terms including 'dementia', 'early diagnosis', 'primary care', 'barriers', 'GP', and 'cognitive assessment'. English-language studies from the past 10–15 years were reviewed, with priority given to UK-based research or comparable NHS-style healthcare systems. Both qualitative and quantitative papers were included. Findings were synthesised using a narrative, theme-based approach aligned with clinician-, patient-, and system-level barriers.

RESULTS
Three interconnected domains of barriers were identified:
Clinician-level barriers: Short consultation times (typically 10 minutes in UK general practice) make in-depth cognitive assessment difficult.[3] GPs report uncertainty in distinguishing early dementia from normal ageing or conditions such as depression and anxiety.[4] Confidence and competence in using validated screening tools , such as the Mini-Mental State Examination (MMSE) or the General Practitioner Assessment of Cognition (GPCOG)  varies widely.[4,5] Attitudinal factors, including therapeutic nihilism around dementia, may also contribute to delayed diagnosis.
Patient- and carer-level barriers: Stigma, fear of diagnosis, and limited awareness of early symptoms frequently delay help-seeking.[3] Patients and families often attribute memory difficulties to normal ageing rather than potential pathology.[5] Cultural beliefs, language barriers, and differences in health-seeking behaviour can compound these delays, particularly in minority ethnic communities, where non-cognitive presentations of dementia are more common.[6]
System-level barriers: Limited access to memory clinics, long referral waiting times, and variable referral pathways between GP practices and specialist services slow the diagnostic process.[2,3] However, continuity of care , the sustained GP–patient relationship , is identified as a protective factor, enabling clinicians to detect subtle changes over time.

CONCLUSION
Barriers to early dementia diagnosis in primary care are multifactorial, spanning clinical, attitudinal, patient, and systemic domains. A co-ordinated response is required: enhanced GP training in cognitive assessment, targeted public awareness campaigns to reduce stigma, streamlined and standardised referral pathways, and adequate resourcing of memory services. Addressing these barriers holistically will be essential to closing the UK's dementia diagnosis gap and improving outcomes for patients and their families.

REFERENCES
1. Koch T, Iliffe S; EVIDEM-ED project. Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review. BMC Fam Pract. 2010;11:52.
2. NHS England Digital. Primary Care Dementia Data, June 2024. Available at: digital.nhs.uk [Accessed April 2026].
3. Aminzadeh F, Molnar FJ, Dalziel WB, Ayotte D. A review of barriers and enablers to diagnosis and management of persons with dementia in primary care. Can Geriatr J. 2012;15(3):85–94.
4. Dening KH. Recognition and assessment of dementia in primary care. Br J Community Nurs. 2019;24(8):383–7.
5. Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord. 2009;23(4):306–14.
6. Bhatt H, Bhatt P, Bhatt S, et al. Early presentations of dementia in a diverse population. Alzheimers Dement. 2025 [early online]. doi:10.1002/alz.14628.
7. National Institute for Health and Care Excellence (NICE). Dementia: assessment, management and support for people living with dementia and their carers. NICE guideline NG97. London: NICE; 2018. Available at: www.nice.org.uk/guidance/ng97 [Accessed April 2026].