[A version of this abstract appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 1 Issue 9, April 2011].
The NHS should offer checks for dementia when people reach 75, the Alzheimer’s Society has suggested.
The Arguments For…
Roughly 750,000 people in the UK have dementia and it would help if it were possible to identify the individuals who need help. Fewer than half of UK citizens with the condition receive a diagnosis, and – as a direct result – often do not receive the care and support they need, according to recent research. Effective screening for dementia is therefore desirable The right time to do such screening would appear to be over the age of 75, i.e. the age at which dementia starts to become more common. Widespread screening might also change social attitudes, thereby removing some of the misplaced stigma associated with this condition in the popular imagination.
The method of screening proposed might involve people being offered a cognitive test when visiting their GP surgery. The test might entail questions on time, date, place, memory and understanding. This test could be backed up by an interview with a relative or carer. Patients with suspected dementia would then be referred to a specialist for full clinical assessment.
The Arguments Against…
The UK National Screening Committee (UK NSC), which advises the NHS, takes the view that tests and treatments would need to improve before such proposals become workable. Tests tend not to be sufficiently reliable; meaning that while dementia may be missed in some patients (“false negatives”), other individuals could be informed they have the disease incorrectly (“false positives”) so resulting in needless distress.
The British Medical Association (BMA) cautions that performing the checks would be time-consuming, resulting in there being less time and resource for providing other services.
Screening for dementia presents particular ethical problems too. It would be necessary to explain why the test was being performed. After a memory impairment had been detected, it would also be necessary to ask patients whether they want to know, because some people do not want to know. They may not want family and friends to know about it either.
Click here for an analysis of the underlying issues.
Brimelow, A. (2011). Dementia checks at 75 urged by Alzheimer’s Society. London: BBC Health News, March 28th 2011.