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

Re: There is no evidence base for proposed dementia screening

I fully agree with the sentiments of this open letter. Rather than restate the reasons here can I simply quote NICE Clinical Guideline 42, Section 1.3.1.1: General population screening for dementia should not be undertaken.

The Government have set up NICE to provide evidence based guidelines to inform management of many different conditions. To quote NICE, “we provide independent, authoritative and evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health, reducing inequalities and variation”.

It is not at all clear why in this case the Government is going against NICE’s view, this is a political and emotive decision rather than any clinical or logical one.

We have stated elsewhere our view that development of services has been driven by the development of medication for dementia which in reality has a much lower effect size than many people realise (1).

Another related issue is, why has memory impairment came to be a psychiatric issue anyway? I have no doubt that established dementia is, where there may be a lack of ability to take decisions, an ability to carry out one’s own self care, or perhaps the emergence of behaviour problems. But simply forgetting things?

At a time of diminishing resources I worry that the increasing emphasis on those with low needs, i.e. on those with memory impairment but not dementia, or very early stage dementia, is diverting resources away from people with established dementia.We need a reasoned debate about the whole issue of dementia and its diagnosis.

References:

(1) Pelosi AJ, McNulty SV & Jackson GA. The role of cholinesterase inhibitors in dementia care needs rethinking. British Medical Journal (2006) 333:491-493

Competing interests: No competing interests

31 December 2012
graham a jackson
consultant old age psychiatrist
NHS Graeter Glasgow & Clyde
Levenrdale Hospital, 510 Crookston Road, glasgow G53 7TU
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