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: https://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

Dementia, as the dominant threat to public health in the developed world, has Intensified pressure for screening. Early diagnosis carries a seductively attractive promise of inevitable benefit. True for many cancers and ischaemic heart disease, but not yet for dementia. Big Pharma allied to patient pressure groups, both have a part to play, but their over promotion of early diagnosis, fuels exaggerated therapeutic expectations from the disappointingly limited acetylcholinesterase inhibitors. NICE has not been Immune from such pressure as the changes in its guidelines indicate.

There is little excuse for seriously delayed diagnosis, but investment in large scale screening, contains hidden costs and relies on a misplaced emphasis on medication, diverting resources from supportive dementia services. Do we really want large numbers of over 65’s and their families, unnecessarily subjected to the anxieties of a diagnosis of ‘possible but unconfirmed early dementia’ ? There are massive implications for primary care, radiology and the enhanced network of surveillance memory clinics struggling to distinguish large numbers of normal minor age related memory change from true dementia?

If screening is to be done it should be well targeted, but commissioners are pressing for inappropriate protocols. Blanket screening of hospital admissions over 75, ignores the difficulties inherent in assessing cognition in an often frenetic emergency system of fast changing clinical variables. Add sleep deprivation and the disorientation occasioned by moving patients several times within 24 hours, to the anxieties generated by this highly charged environment, and it should be clear that this model of dementia screening cannot be valid.

Competing interests: No competing interests

04 January 2013
John J Turner
Physician in Acute Medicine & Geriatric Medicine
University Hospital Aintree
Longmoor Lane Liverpool L9 7AL