Curr Neurol Neurosci Rep (2012) 12:511–519 in addition to specialists, such as geriatricians, neurolo- gists, and psychiatrists. Continued medical education in much of the devel- oping world is currently subsidized by pharmaceutical industries [77], without strict regulations on content or selection of presenters. It is not surprising that many educational and dissemination programs on dementia are biased toward pharmacological approaches and down- play nonpharmacological strategies for managing behav- ioral symptoms [78]. Improvement and expansion of those programs to include dementia require input by both large international agencies and academia. Little is likely to be accomplished without their recognition of dementia as a public health problem in poor popula- tions, with emphasis on prevention of risk factors, early diagnosis, and improved caregiving. Economic Issues Affecting Diagnosis of Dementia in LMIC Economic issues are critical to the control and manage- ment of dementia in LMICs [79]. Economic issues also drive the perceived need for early diagnosis of dementia and differentiation of subtypes [7 ]. To develop appropri- ate and effective policies, resource-poor countries require information about the overall prevalence and clinical burden of dementia in their populations, as well as cost–benefit analysis of accurate diagnosis and improved health care. The human capital contributed by the most able elders, particularly in early stages of the aging process (55– 70 years), is critically needed in developing countries; their experience contributes significantly to both economic pro- ductivity and family stability [80]. One way to visualize the economic costs of dementia is to consider the potential years of healthy life lost to disability (loss of function) and to premature death, through the concept of disability-adjusted life years (DALYs) [81]. Economic impact of disease also can be assessed by quality-adjusted life year (QALY), which combines duration and quality of life [82]. Since most of the dementia cases diagnosed in the developing world are of moderate to advanced severity, the price paid by society, either in DALYs or QALYs, is very high. Cost-comparison analyses use the costs of diagnosis and of pharmacological and psychosocial interventions and oth- er relevant costs to estimate the economic benefits of early diagnosis and early interventions [58, 83, 84]. A lack of mortality and natural history data make such calculations difficult for LMICs. Although not entirely projectable to resource-poor areas, a few general conclusions have been drawn from studies of developed countries [83–85]. First, the net benefits of early identification and intervention 515 exceed costs, with significant savings expected. Second, the earlier the diagnosis and intervention, the greater the net benefits. Finally, caregiver interventions at earlier stages have beneficial economic effects. However, these analyses were not based on direct observations or randomized con- trolled trials, and no such analyses have been made for countries in the developing world. Ethical Issues Related to Diagnosis of Dementia in LMIC Perceptions of the nature of disease, what social scientists call social representations of disease [86], vary widely among different populations and ethnic groups, resulting in the need to adapt educational and counseling programs related to dementia [42]. Low levels of education and health literacy, poor access to health care, and the fact that many elderly subjects live within extended families pose ethical dilemmas that need to be discussed with healthcare workers before an early detection program is implemented in a resource-poor community. The key ethical principles guiding the process of disclosure of diagnosis at early stages in the disease are beneficence, respect for the autonomy of patients, and justice for patients [87, 88]. In other words, the clinician weighs the possible benefits and harm of dis- closure, and this process is related to perceptions about the ability of the patient to understand and/or retain information, the potential psychological impact, and beliefs about the efficacy of treatments [89]. Respecting the patient’s autonomy is based on the notion that every individual has a right to control his/her life, as stated in Black´s Alzheimer Bill of Rights [90]. The principle of justice involves hearing the voice of patients, acknowl- edging their vulnerabilities, giving them a chance to decide important issues while decision making is still possible, and not marginalizing them. Unfortunately, no one has studied preferences or the impact of diagnostic disclosure in developing countries among patients, caregivers, and health professionals. It could be difficult to persuade family members that some signs and symptoms in their elderly relatives are due to a disease of the brain, and not just to the process of aging. The belief that an affected individual will be- come seriously dependent can have disastrous effects, including marital breakdown, suicide by the patient, and social stigma for family members [11, 91]. Attitudes toward dementia diagnoses are often based on religious or spiritual beliefs [92]. These issues are even more sensitive when a dominant gene is implicated in the dementia, possibly resulting in discrimination and/or exclusion [93]. Until research on the impact of disclosure is