Proposed model of early dementia screening cannot be validBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f505 (Published 30 January 2013) Cite this as: BMJ 2013;346:f505
- John J Turner, physician in acute medicine and geriatric medicine1
Dementia is a threat to public health in the developed world, and pressure for screening has intensified.1 Early diagnosis is of benefit for many cancers and ischaemic heart disease, but not yet for dementia. Big Pharma, allied to patient pressure groups, have a part to play, but their overpromotion of early diagnosis fuels exaggerated expectations from acetylcholinesterase inhibitors. The National Institute for Health and Clinical Excellence has not been immune to such pressure, as changes in its guidelines indicate.
Seriously delayed diagnosis is inexcusable, but investment in large scale screening has hidden costs and relies on a misplaced emphasis on drugs, diverting resources from support services. Do we really want large numbers of over 65s and their families 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 changes from true dementia?
If screening is done it should be well targeted, but commissioners are pressing for inappropriate protocols. Blanket screening of people over 75 admitted to hospital ignores the difficulties of assessing cognition in an often frenetic emergency system of quickly changing clinical variables. Add sleep deprivation and disorientation caused by being moved several times within 24 hours to anxieties generated by this highly charged environment, and it becomes clear that this model of dementia screening cannot be valid.
Cite this as: BMJ 2013;346:f505
Competing interests: None declared.