514 of minority populations [50 ] (Table 2). There are other obstacles, particularly to early diagnosis of dementia, that are beyond the scope of this article [51]. However, it is important to recognize that economic crises, epidemics, famine, war, displacement, and natural disasters have dev- astating effects on populations in resource-poor countries, which relegate the health of elderly individuals to low priority [52, 53]. Barriers to improvement of dementia di- agnosis and care are similar to those confronting mental health services [54]. Overcoming those barriers will require changes in politics, leadership, planning, advocacy, and participation [55]. Inarguably, it is crucial to reliably diagnose individ- uals with dementia in order to carry out clinical trials for treatments, to advance genetic studies, and to pro- ceed with epidemiological studies that allow the estab- lishment of specific risk factors. However, because there is no definite marker for the disease (except when relatively rare dominant genetic alterations are present and consistent with symptomatology), population screen- ing and preclinical diagnosis in general populations are not yet cost effective and have not been implemented even in wealthy countries. Even screening for the ApoE-4 allele, the strongest risk factor for Alzheimer´s disease in most populations, is not generally recommen- ded because of prognostic uncertainty [56]. In contrast, screening populations at high risk for dementia (e.g., elderly individuals with a medical history of risk factors for dementia) might be justifiable, but systematic rec- ommendations have not been developed [57]. Neverthe- less, the benefits of early diagnosis, coupled with proper care and caregiver support, outweigh the costs of diag- nosis in developing countries [7 ]. Although the only specific treatment for dementia, cholinesterase inhibitors and/or memantine, is available to a relatively small number of patients, primarily in wealthy countries [58], therapeutic interventions are currently being tested. Now is the time to prepare for their availability. Table 2 Options for and challenges to confronting critical issues in the diagnosis of dementia among minorities that are applicable to resource-poor regions Issues Need culture-unbiased instruments Undetermined value of informant data Assessment of daily functioning Interpretation of conflicting information Curr Neurol Neurosci Rep (2012) 12:511–519 Human Resource Capacity for Diagnosing Dementia in LMICs While the number of specialty centers for dementia care has grown considerably in wealthier countries, apart from a few evolving areas [59–61], facilities for diagnosis and treat- ment of dementia are scarce in LMICs [62]. There is also a paucity of specialists devoted to health care of the elderly and to brain and mental health disorders [63–68]. Neuropsychologists and biometricians who are competent to administer standardized tests to local popula- tions and interpret the results are rare, so normative values that can be appropriately applied by clinicians in diagnosing dementia are even rarer [51, 69]. The Kyoto Declaration of Alzheimer´s Disease International (ADI), on the basis of the recommendations of WHO 2001 [70], recommended inte- grating dementia outreach into existing primary health care, and WHO developed evidence-based guidelines for man- agement of dementia by nonspecialists in LMICs [8]. Nev- ertheless, most primary care physicians and even many specialists in developing countries do not receive suitable training to diagnose dementia and its subtypes [40], despite efforts to remedy this situation during the past few years [71]. Building capacity to recognize and accurately diagnose dementia in LMICs, by training local healthcare personnel, is necessary to expand access to and improve mental health care [7 , 64]. To date, most initiatives for training healthcare workers in dementia diagnosis have depended largely on face-to-face interactions [72, 73], but the role of distance and Web- or mobile-telephone-based training is increasing [74–76]. However, none of the Web-based programs appear to offer training in different languages or to include specific information on assessment of individuals with low levels of education. Capacity-building efforts should also aim to improve referral pathways and promote multidisciplinary care of dementia patients, which will require training of nurses, social workers, and other healthcare personnel, Options Adapt existing tests Develop new instruments Identify key informant Home-based interview Skilled clinician Home-based interview Multidisciplinary consensus on diagnosis Algorithm diagnosis Challenges Comparability Alteration of psychometric properties Need local normative values Stigma Oversimplification of complex social relationships and environments Time consuming Specific to setting Experienced clinical judgment Intimate knowledge of culture