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Targets for dementia diagnoses will lead to overdiagnosis

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2224 (Published 01 April 2014) Cite this as: BMJ 2014;348:g2224

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Re: Targets for dementia diagnoses will lead to overdiagnosis

Martin Brunet highlights the pressure on Herefordshire GPs to increase the number of diagnoses of dementia [1]. As the local memory clinic feels the strain, Herefordshire CCG is now trying to ease the bottleneck by encouraging GPs to make the diagnosis themselves. A recent newsletter stated that “adding a diagnosis of dementia does not require a referral to memory clinic, if the diagnosis is clear and treatment would not be beneficial” [2]. This is contrary to both the NICE Guidelines [3] and the specifications for the “Facilitating Timely Diagnosis” Enhanced Service [4] which make it clear that patients with suspected dementia should be referred for a diagnosis to be made and to have a specialist assessment of the subtype, in order to guide possible treatment and access the support and benefits that early recognition is claimed to provide.

The culture of targets ignores the frequent difficulty and uncertainty in making a diagnosis of dementia, even by specialists in the memory clinic. Treatments are controversial, and it is often not clear who might benefit. Other chronic neurodegenerative conditions such as Parkinson’s Disease can be difficult to diagnose, have major prognostic implications and a range of potential treatments. We accept the need for initial specialist assessment for these conditions, so why should dementia be any different?

[1] 1.Brunet M. Targets for dementia diagnosis will lead to overdiagnosis. BMJ 2014;348:g2224
[2] Herefordshire CCG Mental Health Steering Group Spring Newsletter Spring 2014
http://nhs.us8.list-manage1.com/track/click?u=2a3d2e526198441b385146f25&...
[3] CG 42 Dementia : Nice Guideline 22 November 2006 http://guidance.nice.org.uk/CG42/NICEGuidance/pdf/English
[4]Enhanced Service Specification: Facilitating Timely Diagnosis and Support for people with Dementia. NHS Commissioning Board 2013
http://www.england.nhs.uk/wp-content/uploads/2013/03/ess-dementia.pdf

Competing interests: No competing interests

21 April 2014
Jonathan D Sleath
General Practitioner
Kingstone Surgery
Hereford, HR2 9HN.