Alzheimer's disease: To diagnose or not


A new analysis published in the BMJ adopts an interesting point of view regarding the diagnosis of dementia: ignorance is bliss. They say screening older people for early signs of dementia could lead to unnecessary investigation and potentially harmful treatment for something that occurs naturally.

More screening being called for

In the UK, government policy mandates regular screening of older people for mild cognitive impairment. General practitioners will be rewarded financially for screening patients over the age of 60. In the US, the new Affordable Carte Act includes annual wellness visits to test for cognitive impairments.

But these researchers say it’s unnecessary

Researchers say only 5-10% of people with mild cognitive impairments progress to dementia. As many as 40-70% never progress at all. They also say the tools and tests to measure aren’t reliable. They posit that early screening of dementia could result in 65% of people over the age of 80 being diagnosed with Alzheimer’s disease, and 23% of older people being misdiagnosed with dementia.

And it can’t be treated

There are no drugs for prevention or to stop progression. “Nearly half of the people who have positive results on screening for cognitive impairment refuse subsequent diagnostic evaluation because of concerns about harms associated with a diagnosis such as losing health insurance cover, driving privileges, or employment; anxiety and depression, stigma; and effect on family finances and emotions,” according to the report.

More than a few people disagree and are angered

“It’s astounding to hear talk of an ‘unwanted war’ on dementia when in fact we need nothing less than an all-out fight back. We should be backing doctors up and down the country who are helping ensure people with dementia are diagnosed,” exclaimed Jeremy Hughes, chief executive of the Alzheimer’s Society. “There is surely no other condition where we could tolerate, let alone encourage, people being kept in the dark, without treatments or support and unable to make decisions about their life.”

Source: MedicalNewsToday, BMJ

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