Abstract
Despite efforts to raise awareness and develop guidelines for care of individuals with dementia, reports of poor detection and inadequate management persist. This has led to a call for more identification of people with dementia, that is, screening individuals who may or may not complain of symptoms of dementia in both acute settings and primary care. The following should be considered before recommending screening for dementia among individuals in the general population. Dementia Tests. Low prevalence reduces positive predictive value of tests and screening tests will miss people who have dementia and identify people who do not have dementia in substantial numbers. Clinical Issues. The clinical course of dementia has not yet been shown to be amenable to intervention. Misdiagnosis and overdiagnosis can have significant long-term effects including stigmatization, loss of employment, and autonomy. Economic Issues. Health systems do not have the capacity to respond to increased demand resulting from screening. In conclusion, at present attention to life-course risk reduction and support in the community for frail and cognitively impaired older adults is a better use of limited healthcare resources than introduction of unevaluated dementia screening programs.
Highlights
Dementia is a condition with multiple causes that affects memory, other cognitive abilities, and behaviour that interfere with a person’s ability to drive, deal with their finances, manage their healthcare, and live independently [1]
Alzheimer’s disease and vascular dementia are the most common forms of dementia and other causes are dementia with Lewy bodies and a group of diseases that contribute to frontotemporal dementia [2]
Prevalence of dementia is ∼6% [21] in the general population or in a primary care clinic and this results in the Positive predictive value (PPV) of the test dropping to 34% even with the sensitivity and specificity being held steady (Figure 1(c)) (Table 2)
Summary
Dementia is a condition with multiple causes that affects memory, other cognitive abilities, and behaviour that interfere with a person’s ability to drive, deal with their finances, manage their healthcare, and live independently [1]. The local Alzheimer Association requested advice from the local medical society to introduce an awareness raising campaign to screen for dementia. Practitioners often see individuals who once diagnosed have a clear view that their delay in accessing support and advice from services have caused harm and that this can be remedied by systematic screening. They feel that early detection and remediation could lead to improved quality of life for affected individuals and their caregivers.
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