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Alzheimer's, Dementia & Mental Health

Screening for Minor Memory Problems May Wrongly Label Many with Dementia

Experts 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

Sept. 10, 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.

Their 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

An 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 University.

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. Website

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. 

They 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 dementia.

Dementia 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

For 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.

 

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Read the latest news on Alzheimer's, Dementia & Mental Health

 

This had 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. 

They also 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.

The 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.”

They 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.

“Current 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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