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Clinical Articles, News & Views

Routine early dementia screening “a disaster in slow motion”

The brakes should be put on plans for routine dementia screening, according to a recent announcement from Dr Chris Fox (Norwich Medical School, University of East Anglia, UK) at a TEDMED Live healthcare conference in Bristol.

Dr Fox said that the stigma and anxiety caused by being diagnosed with early dementia, long before symptoms are apparent, greatly outweigh any benefits. This is bolstered by the fact that there is no prospect of an imminent breakthrough in treatment, he added.

Dr Fox said: “World figures for dementia are sky rocketing towards a predicted 60 million in around 10 years. There is no doubt that we are experiencing a dementia tsunami, with the crest of the wave yet to come.”

“But rolling out routine dementia screening will be an even worse disaster in slow motion. People who are diagnosed with very early-stage dementia will be worse off than people who are not diagnosed until their dementia is more apparent.”

“Routine screening means that people will be diagnosed long before they start to show symptoms. The problem is that a diagnosis can turn someone’s life upside down years before dementia itself does. The main thing that comes with a diagnosis of early dementia is a deeply unfortunate label. And in most cases the stigma attached will do far more harm than good,” he continued.

“On a personal level, just knowing that you have this illness coming will lead to all sorts of problems – from profound anxiety and stress for the patient and their families, to a loss of independence, an impact on their career if they are still working, and social isolation. And all of this before symptoms are obvious,” he added.

Dr Fox also said that minor cognitive impairment can often be misdiagnosed as dementia: “Current tests are not particularly robust and there is a relatively high risk of misdiagnosis so all of this turmoil could be even more unnecessary”.

As well as the increased personal stress, Dr Fox believes that increasing numbers of people with an early diagnosis will put an unnecessary financial burden on healthcare systems: “Vast sums of money will need to be diverted to patients who will have a raised expectation of treatment and support – at a time when health and social care systems are struggling to cope with those who are already known to have dementia, and despite treatment options being very limited.”

“At the moment, anyone receiving an early prognosis would receive little more than some medical advice and perhaps some medication that may alleviate certain symptoms for a limited period. It is unfair to cause fear and concern when treatments are not available, the chances of the condition actually progressing are not clear, and when symptoms may never take hold in the patient’s lifetime,” he added.

“Much more must be done before routine screening is rolled out. We don’t know enough about the condition or how it might be managed. There is no prospect of a breakthrough in treatment…We must assess the benefits and harms that come with an early diagnosis. There must be research into who would benefit from an early diagnosis and develop screening tools that are sufficiently robust. And all of this information must be used to predict the economic outcomes for the NHS and other world healthcare providers,” Dr Fox concluded.

Videos of the TEDMED Live conference will be available soon at http://www.bristolhealthpartners.org.uk/tedmedlive-bristol/watch-tedmedlive-bristol/

Published on: May 22, 2013

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