Intended for healthcare professionals

Letters Patient centred diagnosis

Patient centred diagnosis of dementia: we must listen to patients’ wishes

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5524 (Published 07 December 2017) Cite this as: BMJ 2017;359:j5524

The Edinburgh Consensus

I share Dr Devine's professional approach to patient-centred diagnosis of dementia (1)

This approach was enshrined by the Glasgow Declaration of 2014, which has been signed by 153 policy makers (including 84 MEPs) from 25 European countries along with 205 separate organisations (2)

The same day that I was reading Dr Devine's letter I was sent a communication about the "Edinburgh Consensus" (3). I was not aware of the Edinburgh Consensus until I received this communication which confirmed "the operationalisation of the Edinburgh Consensus which is on-going with NHS England and NHS Scotland." I have practised in NHS Scotland for 25 years, I am a specialist in dementia, and I was born In Edinburgh.

The "Edinburgh Consensus" provides this context: "This commentary discusses the implications of disease-modifying treatments for Alzheimer’s disease which seem likely to appear in the next few years and results from a meeting of British experts in neurodegenerative diseases in Edinburgh. The availability of such treatments would help change public and professional attitudes and accelerate engagement with the prodromal and preclinical populations who might benefit from them. However, this would require an updated understanding of Alzheimer’s disease, namely the important distinction between Alzheimer’s disease and Alzheimer’s dementia".

I worry about the potential for harm in conflating risk with disease, especially when understandings are still very much in development (4) The potential for over-medicalization and inverse care cannot be ignored.

Have we here further examples of divides? Between Glasgow, and its Declaration, and Edinburgh and its Consensus?

I fully support research into at-risk states for dementia. However I am concerned that this "consensus", which has been approved by the Faculty of Old Age Psychiatry of the Royal College of Psychiatrists and the Association of British Neurologists, may not have sought to listen to any other voices than their own (5).

[this rapid-response is written in a personal capacity only]

References:
(1) Devine, M. Patient centred diagnosis of dementia: we must listen to patients' wishes. Published7 December 2017. BMJ, 2017;359;j5524
(2) Glasgow Declaration, 2014 - http://www.alzheimer-europe.org/Policy-in-Practice2/Glasgow-Declaration-...
(3) The Edinburgh Consensus: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657110/pdf/13195_2017_Arti...
(4) Wilson and Jungner, World Health organisation, 1968, http://apps.who.int/iris/handle/10665/37650
(5) I was born in Edinburgh (this is a personal perspective to the "Edinburgh Consensus" by Dr Peter J. Gordon): https://holeousia.com/2017/12/11/i-was-born-in-edinburgh/

Competing interests: No competing interests

13 December 2017
Peter J Gordon
Psychiatrist for older adults
NHS West Lothian
Bridge of Allan