In the future the society will have to care for a growing number of psychogeriatric patientns, especially persons with dementia. At first sight an early detection can solve a lot of problems. Still, this paper focuses on the numerous tresholds on the diagnosis and therapy in the pathway of patients and their families. (Early) diagnosis is hampered by obstacles caused by movement of the patient, stigma of the disease and the numerous problems of diagnostic tests, their validity and difficult implementation. A containing treatment also faces tresholds. The use of psychosocial interventions is difficult. For drugs like antidepressants, antipsyschotics and cholinesterase inhibitors it is hard to achieve the right balance. The organisation of home care remains complex in Belgium. Institutionalisation stresses both patients and their caregivers. Last but not least attention has to be given to the processs of advance care planning.