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Experts criticise 'war on dementia' diagnosis

Experts in ageing have criticised ‘the political drive’ to screen older people for dementia, arguing the Government would do better to focus its attention on tackling risk factors for developing the disease.

The international team of academics launched the attack on both UK and US policies on dementia in the BMJ today, saying that the evidence suggests many patients diagnosed with cognitive impairment do not progress to dementia.

They add there are no drugs to prevent progression of dementia or that are effective in mild cognitive impairment, yet many people labelled with dementia or ‘pre-dementia’ will seek non-evidence based therapies.

The researchers questioned the evidence base for the new dementia case-finding DES in England, which will see GPs rewarded for assessing anyone over 75 and over-60s in at-risk groups for dementia and cognitive impairment, and which many practices have already signed up to.

They also single out the Government’s drive to introduce more memory clinics for criticism, saying these increase healthcare costs and stress for patients and their carers, when ‘there is evidence they may be no more effective than standard care by general practitioners’.

They say: ‘Only 5-10% of people with mild cognitive impairment will progress to dementia each year, and as many as 40-70% of people do not progress or their cognitive function may even improve. 

‘Furthermore, many people who develop dementia do not meet definitions of mild cognitive impairment before diagnosis. Some studies have even shown that the development of dementia is higher in people who don’t have symptoms of mild cognitive impairment than in those that do.’

As the researchers highlight, many GPs were opposed to the case-finding DES before it was introduced, with Pulse revealing one group had launched a petition to try to force the Government to rethink the plans.

Campaigners and supporters of the case-finding approach argue it aims to improve the timeliness of diagnosis rather than detect dementia at an earlier stage. However, a recent study suggested dementia diagnosis rates are much better than the Government has previously claimed, raising questions about the rationale for improving detection rates.

The researchers concluded: ‘The desire of politicians, dementia organisations, and academics and clinicians in the field to raise the profile of dementia is understandable, but we risk being conscripted into an unwanted “war against dementia”.

‘The strong political lead in the UK and US is increasing the numbers of people that receive a diagnosis of dementia and early dementia. Yet arguably the political rhetoric expended on preventing the burden of dementia would be much better served by efforts to reduce smoking and obesity, given current knowledge linking mid-life obesity and cigarettes with the risk of dementia.

‘And although increasing the diagnosis rates might raise awareness and perhaps fear of dementia in the community, there is a risk it will result in allocating resources that are badly needed for the care of people with advanced dementia.’

RCGP chair Professor Clare Gerada, said the paper would be ‘welcomed by the thousands of GPs who are concerned about screening for dementia when there is currently no sound science to back it up’.

She said: ‘There is a risk that it creates more problems than it solves by generating false positives that worry patients and their families, as well as increasing unnecessary referrals to secondary care.’

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Readers' comments (3)

  • Can they at least set some money aside to screen High Court Judges.

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  • Disappointing that undiagnosed and unaided hearing loss as a risk factor for accelerating cognitive decline and, quite possibly, developing dementia is not included with obesity and smoking. Is the evidence for a causative connection between dementia and either obesity or smoking greater than for age-related hearing loss? See, for example, Lin et al. (2011) Hearing Loss and Incident Dementia. Arch Neurol 68(2):214–220. Routine screening for hearing loss for all those over 50 years of age might be a better first line of approach.

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  • Is that Barry Downes who works for amplifon?
    Should we not declare an interest?? i appreciate most doctors don't, but I rather think they should!

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