Dementia screening and early diagnosis: The case for and against

Abstract

Over 700,000 people have dementia in the UK. There is increasing policy and practice consensus that early intervention in identifying and treating dementia is beneficial and that much can be done therapeutically and practically to help users and their relatives at an early stage. Research evidences early diagnosis as allowing users the chance to come to terms with it when they can still understand its implications. It also provides an opportunity for key decisions to be made and is what the majority of people want. However, early diagnosis also carries risks: loss of status, acquisition of a stigmatising label, loss of employment and, for a minority, depression. Not all users want to know they have dementia; the diagnosis may also be incorrect. Evidence from the field of medical sociology offers a different perspective on the early intervention debate suggesting not only that targeting ‘well’ older people at possible risk of dementia may be the latest product of surveillance medicine but that efforts to resist being diagnosed may represent strategies to challenge medical intrusion, knowledge and power. Further, the imposition by an older person and their family of their individualised values onto the clinical encounter may be viewed as an attempt to import user generated forms of knowledge into a medically managed process and provide a nuanced approach to defining, and dealing with, risks. Accommodating both perspectives in practice development may hold considerable potential to enhance the nature of care and the quality of lives of people with dementia and their families.

Keywords:

• dementia screening
• early intervention
• medical surveillance
• risk assessment

Acknowledgements

Gratitude is due to my friend and colleague Jo Warner for her very helpful critical readings of earlier drafts of this paper.

Notes

1. Vascular dementia is commonly caused by a stroke or series of small strokes. Brain cells are deprived of oxygen and die. Symptoms tend to remain steady for a time and then suddenly decline as the result of another stroke. This contrasts with the gradual decline common in those with Alzheimer's disease. It can be difficult to determine whether a person has Alzheimer's or vascular dementia; it is possible to be affected by both.

2. Since 2006, the so called anti-dementia drugs - donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon) - are only available for people in the ‘moderate stages’ of Alzheimer's disease (NICE, revised guidance on anti-Alzheimer's drugs). This differs from the previous NICE guidance that indicated these drugs could be also prescribed to people in the early stages of the disease.