Letters Proposed dementia screening

Confusion is everywhere

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f511 (Published 30 January 2013) Cite this as: BMJ 2013;346:f511
  1. Peter J Gordon, consultant psychiatrist for older adults1,
  2. Sian F Gordon, general practitioner2
  1. 1NHS Forth Valley, Clackmannanshire Community Healthcare Centre, Sauchie, Alloa FK10 3JQ, UK
  2. 2Graeme Medical Centre, Falkirk, UK
  1. petergordon{at}nhs.net

Confusion abounds. The recent BMJ discussion about screening for dementia highlighted that it is incorrect and potentially stigmatising to consider such confusion as the preserve of the older generation.1

For example, our elders might highlight:

  • 1. General confusion: The general population increasingly uses the word “Alzheimer’s” instead of “dementia.” This is hardly surprising when you consider:

  • 2. Professional confusion: National Institute for Health and Clinical Excellence and Scottish Intercollegiate Guidelines Network guidelines for dementia contain definitions of dementia and Alzheimer’s disease, yet the terms are used interchangeably in the body of the guidelines.2 3

  • 3. Confused “education”: Much postgraduate medical education is funded by the drug industry, which also funds “awareness raising” by charities and lobbies politicians. We are certainly confused about where the line lies between these activities and “marketing.”4

  • 4. Confusion between research and clinical agendas: Advances in research are often extrapolated prematurely into a general clinical setting by well intentioned clinicians who may also be responding to the clamour of the latest press release.5

  • 5. Confusion about risk: The communication of risk is fundamental to medical practice but is undoubtedly difficult. Every intervention has potential for benefit and for harm. We are so keen to see the benefits that we sometimes forget to look for the harms.6

The dictionary definition of confusion is: “a feeling that you do not understand something or cannot decide what to do.” We must resist the temptation to respond to confusion with oversimplification and instead find a way to acknowledge complexity.


Cite this as: BMJ 2013;346:f511


  • Competing interests: None declared.


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