There is no evidence base for proposed dementia screening

Brunet, Martin; McCartney, Margaret; Heath, Iona; Tomlinson, Jonathan; Gordon, Peter; Cosgrove, John; Deveson, Peter; Gordon, Sian F; Marciano, Sally-Ann; Colvin, Deborah; Sayer, Melissa; Silverman, Ruth; Bhattia, Naureen

doi:10.1136/bmj.e8588

Cited by 72 publications

(48 citation statements)

References 4 publications

(2 reference statements)

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“…1 The hope was that such screening would, if answered in the affi rmative, initiate a 'dementia risk assessment' (exact nature unspecifi ed) and thus help to close the gap between observed and expected numbers of dementia diagnoses. 2 However, concerns have been voiced about the lack of evidence for such a screening policy, 3 and the risk that it might promote overdiagnosis of dementia. 4 Although the screening question may have face validity, its ability to identify patients with and without dementia is, to our knowledge, unknown.…”

Section: Screening For Dementia: Is One Simple Question the Answer?mentioning

confidence: 99%

Screening for dementia: is one simple question the answer?

Aji

Larner

2015

Clinical Medicine

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Section: Screening For Dementia: Is One Simple Question the Answer?mentioning

confidence: 99%

Screening for dementia: is one simple question the answer?

Aji

Larner

2015

Clinical Medicine

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“…However, this has been controversial with critics highlighting the difficulty of accurate diagnosis, particularly in the early stages of dementia, as no more than half of those patients with mild cognitive impairment develop dementia. 3 The lack of appropriate care in the community, fragmented health and social care, and the lack of effective treatment options have also been raised. Finally, this approach to dementia screening fails the UK's own National Screening Committee criteria.…”

mentioning

confidence: 99%

Promoting modifiable risk factors for dementia: is there a role for general practice?

et al. 2015

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The prevalence of dementia is increasing worldwide, with a predicted rise from 35.6 million in 2010 to 115.4 million in 2050. 1 The economic cost of medical, social, and informal care was estimated at £391 billion in 2010 (€533 billion; US$604 billion), exceeding the economies of many countries. 1 The lack of treatment options also increases fear and uncertainty for individuals and their families, leading the English Department of Health to say that 'Among the over-55s, dementia is feared more than any other illness.' 2 The challenge of dementia has been recognised internationally. Many countries have now produced dementia strategies encompassing diagnosis, support for patients and carers, and increased research funding; however, improving diagnosis has been contentious. In England, one particular strategy was to improve the rate of diagnosis and appropriate post-diagnosis support by March 2015. To achieve this, dementia diagnosis was incentivised in general practice by implementing an optional enhanced service under the terms of the general medical services contract. Taking a case-finding approach, practices that joined the enhanced service received a financial payment for every patient assessed for the early signs of dementia. However, this has been controversial with critics highlighting the difficulty of accurate diagnosis, particularly in the early stages of dementia, as no more than half of those patients with mild cognitive impairment develop dementia. 3 The lack of appropriate care in the community, fragmented health and social care, and the lack of effective treatment options have also been raised. Finally, this approach to dementia screening fails the UK's own National Screening Committee criteria.4 Given these difficulties, perhaps the focus should shift from improving early diagnosis to improving mid-life prevention. the role of modifiable risK factors While non-modifiable risk factors, in particular age and genetic factors, play a major role in the development of dementia, an increasing body of evidence has highlighted the role for modifiable risk factors that exacerbate, or reduce, one's risk of developing dementia in later life. 5,6 Good quality evidence exists identifying the following as exacerbating risk: depression; type 2 diabetes; smoking; midlife hypertension; mid-life obesity; physical inactivity; and low educational attainment. Although the evidence is weaker, factors that may reduce the risk include vegetable intake, Mediterranean diet, and increased cognitive activity. Finally, there is weak evidence suggesting that early-life events, such as the death of a parent, and chronic sleep disturbances in mid-life may also exacerbate the risk of developing dementia. 5The importance of cardiometabolic risk factors that develop in mid-life, such as hypertension and obesity, as well as the contribution of smoking and physical inactivity, have led to the view that approaches are required that target populations well before they develop dementia, while still in their 40s and 50s. 5,7 Several countr...

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“…Avoiding overdiagnosis (high specificity) may be more important than finding all possible cases (high sensitivity), as currently there are no drugs that modify the natural history of dementia 41 and there are potential disadvantages from overdiagnosis. 1,11,42 In this study, simple questions had high post-test probability of unspecified dementia. In principle, this raises the possibility that GPs who are considering dementia after evaluating a person with symptoms might be able to make the diagnosis, without specialist input, using relatively simple adjunct questions.…”

Section: Implications For Research and Practicementioning

confidence: 99%