Whether or not physicians should obtain extra reward for doing the job they have undertaken is a separate issue but a financial incentive may make some more willing to learn how to diagnose the different dementing illnesses early in the disease. Contrary to popular belief, it is not difficult to differentiate Alzheimer from Pick disease, Lewy body, Jakob-Creutzfeld, ALS-Parkinson-Dementia etc. in the very early stages. As these diseases progress, they become more and more alike so that the opportunity to identify clinically exists only at the beginning of the process. After many years of teaching by showing videotapes of autopsy-proven patients with various dementing diseases, it still surprises me that so few physicians are taught the differential signs that are very clear once seen. Mini-Mental examinations, clock drawing and other suggested “tests” are inadequate. The same results can be obtained from patients with completely different diseases or from temporary conditions such as delirium or even intoxication. The need to identify early includes the requirement that medications designed to help slow the progress of Alzheimer disease be prescribed for those who actually have the disease instead of being given to anyone and everyone who appears to have an amnestic condition.

Competing interests: None declared