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Dementia screening

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An exploration of the pros and cons of dementia screening/case-finding, in the context of the UK government's dementia strategy in 2013. …

An exploration of the pros and cons of dementia screening/case-finding, in the context of the UK government's dementia strategy in 2013.
Presented to Thames Valley Faculty on 30 April 2013

Published in: Health & Medicine

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  • 1. Dementia ScreeningWelcome!While you’re finding your seats, pleaseconsider the following question:What are the needs of patients withdementia, their families and carers?
  • 2. Dementia ScreeningAnnual symposium ofRCGP Thames Valley Faculty30 April 2013John Cosgrove
  • 3. Dementia Screening•Background•Patient needs•Other benefits of screening•Risks•Who benefits?•How to implement the DES and LES•What might we do instead?
  • 4. BackgroundPrime Minister’s Dementia Challenge•Marketing Plan to raise awareness•Case finding DES (CVD, Down’s, LD, PD)•NHS Health Checks: awareness & signposting
  • 5. What are the needs of patients withdementia, their families and carers?•Support•personal care•emotional support•carer support•financial (benefits)•Signposting
  • 6. What are the needs of patients withdementia, their families and carers?•Advance planning•Lasting power of attorney•Equipment•Memory aids
  • 7. What are the needs of patients withdementia, their families and carers?•Treat reversible causes•Effective treatment•Manage comorbidities•Reduce stigma
  • 8. What other benefits might a dementiascreening programme have?•Prevalence (determine & increase)•Establish need for resources•Raise priority for research
  • 9. What are the risks of a dementiascreening programme?•Medicalise ageing•Disengagement of informal carers•Opportunity costs•those with health care needs but different orno diagnosis•diversion of resources from those in greatestneed
  • 10. What are the risks of a dementiascreening programme?•GP time for referrals•Anxiety (itself causing cognitive impairment)•during testing•uncertain prognosis of MCI•poor prognosis of dementia•False hope•Unrealistic expectations
  • 11. What are the risks of a dementiascreening programme?•Insurance•Misperception of capacity•family disharmony•financial abuse
  • 12. Who benefits from dementiascreening?•Some patients/carers•Primary care (£3000 for DES; LES)•Secondary care•Pharmaceutical industry•Politicians•Research
  • 13. How to implement the DESWhich cognitive test?•Quick•High specificity•Good sensitivityMini-COG•2-4 min•89% specificity•76% sensitivity
  • 14. How to implement the LES
  • 15. What might we do instead?(aka alternative DES)•Collaboration between GP, SS, psych, families•Outreach clinics•Shared/patient-held record•GP multimorbidity clinic•Advance planning support•GP diagnosis
  • 16. What else might help?
  • 17. ReadingGrassrootsGP.org/dementia-screeningMendeley list•John@DrCosgrove.net
  • 18. Reading•Angermeyer MC, Holzinger A, Carta MG, et al. Biogenetic explanations and publicacceptance of mental illness: systematic review of population studies. The BritishJournal of Psychiatry 2011;199:367–72.•Armstrong R. General Medical Services – Contractual Changes 2013/2014. Letter tothe Chairman of the General Practitioner’s Committee.2012.https://www.wp.dh.gov.uk/publications/files/2012/12/GMS-Contract-letter.pdf(accessed 16 Dec2012).•Banerjee S, Willis R, Matthews D, et al. Improving the quality of care for mild tomoderate dementia: an evaluation of the Croydon Memory Service Model.International journal of geriatric psychiatry 2007;22:782–8.•Brayne C. The elephant in the room - healthy brains in later life, epidemiology andpublic health. Nature Reviews Neuroscience 2007;8:233–9.•Brayne C, Davis D. Making Alzheimer’s and dementia research fit for populations. TheLancet 2012;380:1441–3.•Brayne C, Fox C, Boustani M. Dementia screening in primary care: is it time. Journal ofthe American Medical Association 2007;298:2409–11.•Brunet MD, McCartney M, Heath I, et al. There is no evidence base for proposeddementia screening. BMJ 2012;345:e8588–e8588.•Brunet MD, McCartney M, Heath I, et al. Re: Open Letter to The Prime Minister andthe Chief Medical Officer Regarding Proposals to Introduce Screening for Dementia.British Medical Journal (Rapid Response).2012.http://www.bmj.com/content/344/bmj.e2347/rr/621214 (accessed 7 Jan2013).
  • 19. Reading•Brunet MD, McCartney M, Tomlinson J, et al. Open Letter to The PrimeMinister and the Chief Medical Officer Regarding Proposals to IntroduceScreening for Dementia. British Medical Journal (Rapid Response).2012.http://www.bmj.com/content/344/bmj.e2347/rr/619428 (accessed 7Jan2013).•Bunn F, Goodman C, Sworn K, et al. Psychosocial Factors That Shape Patientand Carer Experiences of Dementia Diagnosis and Treatment: A SystematicReview of Qualitative Studies. PLoS Medicine 2012;9:e1001331.•Burns A, Iliffe S. Dementia. BMJ 2009;338:b75–b75.•Courtney C, Farrell D, Gray R, et al. Long-term donepezil treatment in 565patients with Alzheimer’s disease (AD2000): randomised double-blind trial.Lancet 2004;363:2105–15.•Department of Health. The mandate—a mandate from the government tothe NHS Commissioning Board: April 2013 to March 2015. 2012.•George DR, Qualls SH, Camp CJ, et al. Renovating Alzheimer’s: “Constructive”Reflections on the New Clinical and Research Diagnostic Guidelines. TheGerontologist Published Online First: 2012. doi:10.1093/geront/gns096•George DR, Whitehouse PJ, D’Alton S, et al. The art of medicine: Through theamyloid gateway. Lancet 2012;380:1986–7.•Gordon PJ. Window tax. Mental Health and Social Inclusion 2012;16:181–7.
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