With dementia ever-increasing in prevalence and cost on society, and with recent reports emphasizing the need for improved and standardized diagnosis and care for patients with dementia, the National Dementia Strategy (NDS) has been published by the English Department of Health. The NDS encourages the identification of successful innovations to implement on a wider scale. This paper uses case studies to describe some examples of innovative practice in the diagnosis and management of patients with dementia in primary care. It goes on to discuss methodological problems in the evaluation and comparison of innovations in practice, focusing on the potential to compare complex with simple interventions, and recognizing the role that commissioners play in making decisions about the choice and implementation of innovation.