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Targets for dementia diagnoses will lead to overdiagnosis

BMJ 2014; 348 doi: (Published 01 April 2014) Cite this as: BMJ 2014;348:g2224

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Re: Targets for dementia diagnoses will lead to overdiagnosis

Dementia’s deadly twin: delirium

Brunet provides a welcome corrective to the troublingly rigid consensus that, when diagnosing dementia, early equates to timely.1 Dementia has now become the preserve of specialists sitting within prescription-oriented memory clinics.2 However, for most sufferers from dementia, it is a geriatric syndrome of multifactorial aetiology that demands a multicomponent approach by family, social and medical care teams rather than a complex neuropsychological approach 3. Recognising vulnerability to cognitive decline within general practice by ascertaining risk factors such as age, vascular morbidity, episodes of delirium and functional limitations may provide opportunities for safeguards against future cognitive decline. In this regard, a “Stop Delirium” model of care (optimising prescriptions, social stimulation, nutrition, hydration, mobility, pain control, sensory functions) may be helpful in formulating care plans to protect those at risk of dementia and those who have crossed thresholds for dementia already 4. The potentially catastrophic impact of delirium in the very elderly (including a 9-fold risk of dementia and 3-fold risk of accelerated functional decline in those with a pre-existing dementia) 5 means that militating against delirium must not be forgotten amidst the pressures to identify people in need of a diagnosis of dementia.

1.Brunet M. Targets for dementia diagnosis will lead to overdiagnosis. BMJ 2014;348:g2224
2 Pelosi AJ, McNulty SV, Jackson GA. Role of cholinesterase inhibitors in dementia care needs rethinking. BMJ 2006;333:491-93.
3 Brayne C, Davis D. Making Alzheimer's and dementia research fit for populations. Lancet 2012; 380: 1441-1443
4 Siddiqi N et al. Stop Delirium! A complex intervention to prevent delirium in care homes: a mixed-methods feasibility study . Age and Ageing 2011; 40 (1): 90-98.
5 Davis, D et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain 2012; 135(Pt 9):2809-16.

Competing interests: I have accepted speaker fees from Lundbeck and Pfizer (who market antialzheimer drugs)

20 April 2014
Simon Philip Thacker
Consultant Psychiatrist
Derbyshire Healthcare NHS Foundation Trust
Kingsway Hospital, Derby, DE22 3LZ