Predicting dementia

Nobody will dispute that people seeking medical advice for cognitive complaints, behavioural problems, or mood changes deserve access to a careful clinical assessment. Above all, comprehensive appraisal of possible early signs of dementia requires time, knowledge, and experience. It can lead to either reassurance, identification of remediable causes for the complaints, or a diagnosis of dementia. In the latter case, people with dementia and their carers could benefit from professional support to prepare for the important changes in functioning that lie ahead and the necessary decisions on living accommodation or any other aspect of care. Depending on the specific clinical profile of symptoms, they can be offered symptomatic drug treatment.

So much for the consensus on the clinical diagnostic approach towards dementia. More controversial is the timing of the diagnostic process and the exact role of brain scans and biomarkers. In a linked paper, Stephan and colleagues (doi:10.1136/bmj.h2863) add much needed evidence to this debate.1

While a failure to recognise early symptoms of dementia can cause anxiety, distress, or crises in both patients and caregivers, a …