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Public health and therapeutic measures to reduce cardiac and stroke risk may already be reducing risks of dementia in populations. In routine clinical care, dementia risk could be further reduced by optimized management of delirium, depressive disorders, traumatic brain injury and stroke. These are opportunities to minimize risk of progression to dementia during acute care and subsequent rehabilitation. Although interventions to protect against progress to dementia may be of small effect in each clinical situation, awareness of dementia risk and appropriate steps to reduce that risk should contribute to an overall reduction in the incidence of dementia.

The emergence of advanced genetic technologies raises many challenges for dementia care and the conduct of related social, behavioural and clinical research. Genetic tests are already used to identify possible participants in dementia prevention trials. These tests are unlike any other in clinical medicine as they have the capacity to predict disease onset after intervals of many years with implications for other family members. Genetic counselling professionals support services in paediatrics, cancer diagnosis and some adult-onset diseases. Their capacity cannot meet the needs for pre- and post-test support of the many “at-risk” families living with late onset dementia. Most dementias are common, complex conditions in which multiple genetic and environmental factors play important and potentially modifiable roles. Large scale prevention studies are needed to test the effectiveness of interventions. Some economy of effort will be achieved by the preferential inclusion of “at-risk” families. Many such families are in contact with dementia care services and will be motivated to participate in prevention studies. However, practice standards and consensus-based guidelines do not yet exist. Support services are not available on a scale sufficient to prevent harm when risk is poorly communicated causing unnecessary psychological morbidity in unaffected family members. There is a pressing need for research to inform the development of study guidelines and to identify how services are strengthened to support these families during and after their participation in trials. Discourse analysis provides a useful method to collect and analyse data of this type and supports the conclusions of this review.

AIM To demonstrate the benefits of collecting family history systematically to enhance the care provided to families living with dementia. In addition, to identify the contribution nurses can make in responding to relatives' concerns about dementia and its risk factors. METHOD An individual case study was derived from a larger observational study of the psycho-educational needs of families affected by dementia. This case study presents extracts from one anonymised interview with an adult son whose father has dementia. FINDINGS The family of the patient with dementia did not feel they had a positive experience of care delivery. Although they had a high level of knowledge and personal experience of dementia, their beliefs and concerns appear to have been overlooked by healthcare staff. This may have led to a delay in the diagnosis of dementia and missed opportunities for earlier treatment. CONCLUSION Healthcare staff should consider the concerns expressed by people with dementia and their families. Knowledge of the risk factors for dementia and risk-reduction strategies can improve the care nurses provide. This should include an increased awareness of the complex interaction between genes, environment and lifestyle.