Dementia ScreeningWelcome!While you’re finding your seats, pleaseconsider the following question:What are the needs of patients withdementia, their families and carers?
Dementia ScreeningAnnual symposium ofRCGP Thames Valley Faculty30 April 2013John Cosgrove
Dementia Screening•Background•Patient needs•Other benefits of screening•Risks•Who benefits?•How to implement the DES and LES•What might we do instead?
BackgroundPrime Minister’s Dementia Challenge•Marketing Plan to raise awareness•Case finding DES (CVD, Down’s, LD, PD)•NHS Health Checks: awareness & signposting
What are the needs of patients withdementia, their families and carers?•Support•personal care•emotional support•carer support•financial (benefits)•Signposting
What are the needs of patients withdementia, their families and carers?•Advance planning•Lasting power of attorney•Equipment•Memory aids
What are the needs of patients withdementia, their families and carers?•Treat reversible causes•Effective treatment•Manage comorbidities•Reduce stigma
What other benefits might a dementiascreening programme have?•Prevalence (determine & increase)•Establish need for resources•Raise priority for research
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
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
What are the risks of a dementiascreening programme?•Insurance•Misperception of capacity•family disharmony•financial abuse
Who benefits from dementiascreening?•Some patients/carers•Primary care (£3000 for DES; LES)•Secondary care•Pharmaceutical industry•Politicians•Research
How to implement the DESWhich cognitive test?•Quick•High specificity•Good sensitivityMini-COG•2-4 min•89% specificity•76% sensitivity
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
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