Keywords: Dementia, Mild Cognitive Impairment, Screening, Barriers

Background:

In Slovakia, approximately 60,000 individuals are affected by dementia, with an estimated 30,000 cases remaining undiagnosed. General practitioners (GPs) play a pivotal role in dementia screening, however, multiple barriers hinder the routine assessment of patients over 60 years of age. The largest health insurance provider in Slovakia mandates the use of the Montreal Cognitive Assessment (MoCA) for dementia screening, which requires 10–15 minutes to administer. Meanwhile, the second largest insurer insists on its test and the third existing insurer does not support dementia screening at all.

Research questions:

This study aimed to assess the current status and barriers of dementia and mild cognitive impairment (MCI) screening by GPs in Slovakia

Method:

A cross-sectional qualitative survey conducted among 650 GPs affiliated with the Society of General Practitioners of Slovakia (SGPS). Participants were invited via email to complete an anonymous, structured 17-item questionnaire covering demographics, knowledge and implementation of dementia screening, perceived barriers, and suggestions for improvement. Data collection occurred over one month, and descriptive statistics were used for analysis.

Results:

99% of GPs recognized the importance of dementia screening. However, 58% expressed dissatisfaction with the current screening process. While 43% frequently encountered patients with suspected dementia, 54% reported rarely or never performing screening test. The most frequently cited barriers were lack of time (88%), limited access to specialists for definitive diagnosis and management (42%), and inadequate reimbursement (34%). Additional challenges included inconsistent screening requirements among insurers and patient reluctance due to potential consequences (e.g., loss of driving or firearms licenses).

Conclusions:

GPs in Slovakia find dementia and MCI screening important. Lack of time and poor follow-up care were identified as the strongest barriers.

Points for discussion:

What is the approach regarding demencia and MCI in primary care in your country?

Which of the validated short tests is suitable for the GPs office environment?