As our physical bodies give out and we look in horror into the mirror seeing our father or mother looking back at us, we comfort ourselves that we have at least our own personality, memories and individuality. But to lose these is to lose everything. So many fear dementia above all other illnesses. Due to the ageing population there is talk of a pending “national crisis” in dementia, and this particular medical bandwagon is beginning to play politically internationally. Is there a counter view to all this unbridled opportunism for more testing?
There has been much talk of the need for early diagnosis, memory clinics, training, screening and claims that 75 per cent of cases go unrecognised. Newspapers are full of talk that doctors need to start testing. Dementia charities use familiar rhetoric, demanding the “right to a diagnosis” and talk about the “treatment gap”, suggesting more people should be on dementia medication. The internet is spawning online testing questionnaires “do you have dementia?” to aid and promote self diagnosis. Regulatory authorities now promote the use of medication in patients even considered to have “mild dementia”. There is a drive to get a diagnosis and underdiagnosis is presented as the problem. Now, intuitively and emotionally this may seem like just good medicine, for such an important and pressing illness.
Dementia or mild cognitive impairment?
But it is not that simple. There is another issue that is poorly understood and only recently recognised even in medical circles: the potential for overdiagnosis of dementia. This would see people misdiagnosed with dementia who do not have dementia.
For there is a common condition that can mimic early dementia called mild cognitive impairment (MCI). This condition causes impaired memory and forgetfulness, the simple effects of normal ageing. And as we age, who doesn’t struggle to remember names and recall certain events? This is not dementia and most people do not progress to full blown dementia. Staggeringly, MCI is reported in 22 per cent of those over 75. But the problem is clinically difficult to distinguish from mild dementia, even when using the latest brain scanning technology and memory testing programmes. And doctors being only human, stung by media criticism, will “make the diagnosis” rather than later being accused of misdiagnosis. So here is the problem: Dementia is a devastating diagnosis, progressive, untreatable, leading to dependence and institutionalisation. Inevitably, some patients with MCI will be told they have dementia when they do not. Millions of the old and their families are potentially affected. Who knows what impact this might have? How would you feel if you had an untreatable condition that would see the loss of everything you hold dear? How would we view the future of our relationships and finances? Many people diagnosed with Alzheimer’s, like the author Sir Terry Pratchett, would vow to take their own lives with such a diagnosis.
Next page … And what is the evidence for early diagnosis of dementia having any benefits?
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