Observations Open letter to the prime minister and chief medical officer for England

There is no evidence base for proposed dementia screening

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8588 (Published 27 December 2012) Cite this as: BMJ 2012;345:e8588
  1. Martin D Brunet, general practitioner, Binscombe Medical Centre, Godalming, GU7 3PR,
  2. Margaret McCartney, general practitioner, Fulton St Medical Practice, Glasgow,
  3. Iona Heath, retired general practitioner and former president, Royal College of General Practitioners ,
  4. Jonathan Tomlinson, general practitioner, Lawson Practice, Hackney, London,
  5. Peter Gordon, consultant psychiatrist for older adults, NHS Forth Valley,
  6. John Cosgrove, general practitioner, High St Surgery, Birmingham,
  7. Peter Deveson, general practitioner, Derby Medical Centre, Epsom,
  8. Sian Gordon, general practitioner, Graeme Medical Centre, Falkirk,
  9. Sally-Ann Marciano, registered general nurse and dementia campaigner,
  10. Deborah Colvin, general practitioner and local medical committee chair, Lawson Practice, Hackney, London,
  11. Melissa Sayer, general practitioner, Statham Grove Surgery, Stoke Newington, London,
  12. Ruth Silverman, general practitioner, Statham Grove Surgery, Stoke Newington, London,
  13. Naureen Bhattia, general practitioner, Limehouse Surgery, London
  1. Correspondence to: M D Brunet martin{at}binscombe.net

Although we welcome the government’s attention to dementia and its timely diagnosis, we are writing to express concerns about the potential consequences of the recent announcement by the health secretary of a “dementia case finding scheme.” The proposal is that doctors should “proactively” ask patients at risk of dementia—including all those aged 75 or over—about their memory, and offer a screening test.1 2

This proposal has moved beyond the raising of awareness about dementia and amounts to a clear intention to screen a section of the population for the condition, without the articulation of any evidence that it fulfils the established criteria for screening. This could lead to overtreatment, harm to patients, unnecessary expense, and diversion of precious resources away from other services, including support for people who are seeking help for a timely diagnosis of dementia or who have already been given a diagnosis. We argue that before any screening programme is introduced it must be shown that the benefits outweigh any potential harm.3 Screening for dementia must be assessed in the same way as any other screening intervention.

We acknowledge the prevailing view that early diagnosis (if an accurate diagnosis were possible) …

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