Alzheimer's, Dementia & Mental Health
for Minor Memory Problems May Wrongly Label Many with Dementia
gather in New Hampshire today to discuss threat to health, the waste of
money by unnecessary care; Medicare covers annual cognitive test
in wellness visit
2013 – The ongoing debate in medical circles over when people – in
particular senior citizens – should be screened for various afflictions
has not hit the battle against dementia. A political drive, led by the
UK and US, to screen older people for minor memory changes (often called
mild cognitive impairment or pre-dementia) is leading to unnecessary
investigation and potentially harmful treatment for what is arguably an
inevitable consequence of ageing, warn experts on bmj.com today.
views come as the Preventing Overdiagnosis conference opens in New
Hampshire, USA today, partnered by BMJ’s Too Much Medicine campaign,
where experts from around the world will gather to discuss how to tackle
the threat to health and the waste of money caused by unnecessary care.
Preventing Overdiagnosis Conference
international scientific conference called
Preventing Overdiagnosis will take place on Sept. 10-12,
2013 at Dartmouth, hosted by The Dartmouth Institute for Health
Policy and Clinical Practice, in partnership with one of the
world’s most respected medical journals, the BMJ, the leading
New-York based consumer organization Consumer Reports, and Bond
Overdiagnosis happens when people
get a diagnosis they don’t need. It can happen when people
without symptoms are diagnosed and then treated for a disease
that won’t actually cause them any symptoms, and it can happen
for people whose symptoms or life experiences are given a
diagnostic label which will bring them more harm than good.
A team of
specialists in Australia and the UK say that expanding diagnosis of
dementia will result in up to 65% of people aged over 80 having
Alzheimer’s disease diagnosed – and up to 23% of non-demented older
people being labeled with dementia.
argue this policy is not backed by evidence and ignores the risks, harms
and costs to individuals, families and societies. It may also divert
resources that are badly needed for the care of people with advanced
is age related and with an ageing population is predicted to become an
overwhelming and costly problem. But the evidence suggests that while 5
- 15% of people with mild cognitive impairment will progress to dementia
each year, as many as 40 -70% will not progress and indeed their
cognitive function may improve.
Studies also show that the clinical
tools used by doctors to diagnose dementia are not robust, and that many
people who develop dementia do not meet definitions of mild cognitive
impairment before diagnosis. But this has not deterred countries from
developing policies to screen for pre -dementia.
Medicare cover annual cognitive impairment test
example, in the US, the Medicare insurance program will cover an annual
wellness visit to a physician that includes a cognitive impairment test.
In England, the government has announced that it will reward general
practitioners for assessing brain function in older patients – and has
committed to have “a memory clinic in every town and every city” despite
no sound evidence of benefit.
Although experts say middle-aged
men should not have routine PSA tests, majority of older men disagree,
especially those of higher income, black or had recent test
July 11, 2013
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Alzheimer's, Dementia & Mental Health
led to the development of imaging techniques and tests that are
increasingly used in diagnosis, despite uncertainty over their accuracy,
say the authors. The researchers say however, that until such approaches
are shown to be beneficial to individuals and societies they should
remain within the clinical research domain.
Furthermore, there are no drugs that prevent the progression of dementia
or are effective in patients with mild cognitive impairment, raising
concerns that once patients are labeled with disease or pre-disease,
they may try untested therapies and run the risk of adverse effects.
question whether ageing of the population is becoming a “commercial
opportunity” for developing screening, early diagnosis tests and
medicines marketed to maintain cognition in old age.
desire of politicians, dementia organizations, and academics and
clinicians in the field to raise the profile of dementia is
understandable, write the authors, “but we risk being conscripted into
an unwanted war against dementia.”
suggest that the political rhetoric expended on preventing the burden of
dementia would be much better served by efforts to reduce smoking and
obesity, given current knowledge linking mid-life obesity and cigarettes
with the risk of dementia.
policy is rolling out untested and uncontrolled experiments in the
frailest people in society without a rigorous evaluation of its benefits
and harms to individuals, families, service settings, and
professionals,” they conclude.
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