There is an increase in cognitive impairment in populations in the developed and developing world as populations age, with over half the cases being caused by Alzheimer’s disease. The number of people with dementia is increasing globally, in line with the ageing profile of the population in each country. In the United Kingdom, it has been established that dementia costs more than cancer, heart disease and stroke put together (Dementia UK 2007). The recent report from the Alzheimer Society of Canada (2009) has reached a similar conclusion, which is that we need to do more. Very many countries are generating their national dementia strategies in response to this challenge. From my work internationally with health and social care workers, I have come to the conclusion that the most significant action we can take is to improve the personal effectiveness of each and every practitioner. Every occupational therapist needs to be thinking carefully of his or her own potential contribution. If the role of the occupational therapist in care for dementia is crucial, this requires a response from universities and colleges to increase the educational elements on dementia in undergraduate and pre-registration programmes. A Scottish survey indicated that there is not much practical input into programmes (Cunningham et al 2006). For example, on one issue alone, occupational therapists need to know much more about dementiafriendly design and technology, so that they can advise people with dementia and their carers on how to maximise their independence at home. Simple measures such as increasing the light levels can make a huge difference, but carers tell me: ‘We were never told … ’ The journey of two people with dementia, even with the same level of underlying pathology, can go in completely different ways. One can maintain independence till right before the end of life, and another can be ushered