Screening for Dementia -- Is It a No Brainer?
Screening for Dementia -- Is It a No Brainer?
In the UK, NICE (Support for commissioning dementia care April 2013-http://publications.nice.org.uk/support-for-commissioning-dementia-care-cmg48) emphasises that people suspected of having dementia should be asked if they wish to know the diagnosis (which implies that they would agree to go further with testing, although looking for underlying causes of cognitive impairment would presumably still be provided as part of normal clinical care) and with whom this should be shared. It is also recognised that some will not benefit from a diagnosis.
However, the new NHS Direct Enhanced Service (DES) for dementia (http://www.england.nhs.uk/resources/resource-primary/) goes further than this. The DES indicates that consideration of dementia should be applied to 'at-risk' patients with income for GPs attached to testing particular groups: (i) people aged 60 and over with cardiovascular disease, stroke, peripheral vascular disease or diabetes; (ii) people aged 40 and over with Down's syndrome; (iii) other people aged 50 and over with learning disabilities; (iv) people with long-term neurological conditions who have a known neurodegenerative element, for example, Parkinson's disease.
These assessments will be in addition to other opportunistic investigations carried out by the GP practice (e.g., anyone presenting with a memory concern). This new initiative is effectively a mixture of population screening and case finding despite the clearly articulated lack of recommendation for population screening reflecting the lack of robust evidence for either (United States Preventative Services Task force review policy advice groups; the UK National Screening Committee and UK National Standard Standards Body-NICE 2013).
Some of the recent arguments for screening are shown in Table 1 (see also ).
Screening and Diagnosis
In the UK, NICE (Support for commissioning dementia care April 2013-http://publications.nice.org.uk/support-for-commissioning-dementia-care-cmg48) emphasises that people suspected of having dementia should be asked if they wish to know the diagnosis (which implies that they would agree to go further with testing, although looking for underlying causes of cognitive impairment would presumably still be provided as part of normal clinical care) and with whom this should be shared. It is also recognised that some will not benefit from a diagnosis.
However, the new NHS Direct Enhanced Service (DES) for dementia (http://www.england.nhs.uk/resources/resource-primary/) goes further than this. The DES indicates that consideration of dementia should be applied to 'at-risk' patients with income for GPs attached to testing particular groups: (i) people aged 60 and over with cardiovascular disease, stroke, peripheral vascular disease or diabetes; (ii) people aged 40 and over with Down's syndrome; (iii) other people aged 50 and over with learning disabilities; (iv) people with long-term neurological conditions who have a known neurodegenerative element, for example, Parkinson's disease.
These assessments will be in addition to other opportunistic investigations carried out by the GP practice (e.g., anyone presenting with a memory concern). This new initiative is effectively a mixture of population screening and case finding despite the clearly articulated lack of recommendation for population screening reflecting the lack of robust evidence for either (United States Preventative Services Task force review policy advice groups; the UK National Screening Committee and UK National Standard Standards Body-NICE 2013).
Some of the recent arguments for screening are shown in Table 1 (see also ).
