Let me just start, because as I indicated to you, I'm a physician. I totally missed my wife's diagnosis, and it was only caught because I developed a very temporary neurological problem that brought me to the attention of a neurologist; he then recognized, as I was coming out of my problem, that I was going to be okay, but he was worried about my wife.
So I think that's a very important question. I was just thinking about it as I was on the plane, while they were de-icing it. There are the sorts of things that happened when the stroke strategy was introduced, and they had those very visual types of things on television--you know, with the pounding. I think that is really a very visible way that people can understand what is happening. What are the early signs of dementia? What is dementia versus normal aging? How do you tell them apart? I think that's a really important thing.
As part of that, I think there's also this whole education piece and this whole issue of the stigma. People are afraid to talk about it, either people with early dementia--it is an exception--or caregivers who are embarrassed about the fact that their loved one has developed dementia. I think somehow dealing with the stigma is really going to be an important issue.
I think the next thing is the whole issue of the primary care provider and equipping that primary care provider with the tools for the early diagnosis intervention. As far as I know from talking to my colleagues, there is no one single tool that most family doctors can apply in order to begin to even suspect dementia, nor is there any way in the system that family doctors are rewarded for spending the time to diagnose dementia. Somehow I think looking at the whole fee schedule is probably beyond this committee, but I think it's an important issue, because right now doctors, including me when I was practising, are rewarded for volume, not for quality and not for outcomes. I think somehow changing how doctors get rewarded...so that primary care physicians actually spend the appropriate amount of time to diagnose dementia and are rewarded commensurate with that time.
Those would be my early thoughts on that.