Dementia ScreeningWelcome!While you’re finding your seats, pleaseconsider the following question:What are the needs of pat...
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 L...
BackgroundPrime Minister’s Dementia Challenge•Marketing Plan to raise awareness•Case finding DES (CVD, Down’s, LD, PD)•NHS...
What are the needs of patients withdementia, their families and carers?•Support•personal care•emotional support•carer supp...
What are the needs of patients withdementia, their families and carers?•Advance planning•Lasting power of attorney•Equipme...
What are the needs of patients withdementia, their families and carers?•Treat reversible causes•Effective treatment•Manage...
What other benefits might a dementiascreening programme have?•Prevalence (determine & increase)•Establish need for resourc...
What are the risks of a dementiascreening programme?•Medicalise ageing•Disengagement of informal carers•Opportunity costs•...
What are the risks of a dementiascreening programme?•GP time for referrals•Anxiety (itself causing cognitive impairment)•d...
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 ...
How to implement the DESWhich cognitive test?•Quick•High specificity•Good sensitivityMini-COG•2-4 min•89% specificity•76% ...
How to implement the LES
What might we do instead?(aka alternative DES)•Collaboration between GP, SS, psych, families•Outreach clinics•Shared/patie...
What else might help?
ReadingGrassrootsGP.org/dementia-screeningMendeley list•John@DrCosgrove.net
Reading•Angermeyer MC, Holzinger A, Carta MG, et al. Biogenetic explanations and publicacceptance of mental illness: syste...
Reading•Brunet MD, McCartney M, Tomlinson J, et al. Open Letter to The PrimeMinister and the Chief Medical Officer Regardi...
Reading•J B. Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine areefficacious for mild to moderat...
Reading•Rasmussen J, Greaves I, Cartmell N, et al. Re: Open Letter to The Prime Minister andthe Chief Medical Officer Rega...
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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.
Presented to Thames Valley Faculty on 30 April 2013

Published in: Health & Medicine
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Dementia screening

  1. 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. 2. Dementia ScreeningAnnual symposium ofRCGP Thames Valley Faculty30 April 2013John Cosgrove
  3. 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. 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. 5. What are the needs of patients withdementia, their families and carers?•Support•personal care•emotional support•carer support•financial (benefits)•Signposting
  6. 6. What are the needs of patients withdementia, their families and carers?•Advance planning•Lasting power of attorney•Equipment•Memory aids
  7. 7. What are the needs of patients withdementia, their families and carers?•Treat reversible causes•Effective treatment•Manage comorbidities•Reduce stigma
  8. 8. What other benefits might a dementiascreening programme have?•Prevalence (determine & increase)•Establish need for resources•Raise priority for research
  9. 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. 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. 11. What are the risks of a dementiascreening programme?•Insurance•Misperception of capacity•family disharmony•financial abuse
  12. 12. Who benefits from dementiascreening?•Some patients/carers•Primary care (£3000 for DES; LES)•Secondary care•Pharmaceutical industry•Politicians•Research
  13. 13. How to implement the DESWhich cognitive test?•Quick•High specificity•Good sensitivityMini-COG•2-4 min•89% specificity•76% sensitivity
  14. 14. How to implement the LES
  15. 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. 16. What else might help?
  17. 17. ReadingGrassrootsGP.org/dementia-screeningMendeley list•John@DrCosgrove.net
  18. 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. 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.
  20. 20. Reading•J B. Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine areefficacious for mild to moderate Alzheimer’s disease. 2012.doi:10.1002/14651858.CD005593•Knapp M, Prince M, Albanese E, et al. Dementia UK: A report into the prevalence andcost of dementia prepared by the Personal Social Services Research Unity (PSSRU) atthe London School of Economics and the Institute of Psychiatry at King’s CollegeLondon, for the Alzheimers Society. London: 2007.•Koekkoek PS, Janssen J, Kappelle LJ, et al. Early detection of dementia: not only doomand gloom. BMJ Rapid Responses.2013.http://www.bmj.com/content/345/bmj.e8588/rr/629558 (accessed 11Feb2013).•Manthorpe J, Samsi K, Campbell S, et al. From forgetfulness to dementia: clinical andcommissioning implications of diagnostic experiences. British Journal of GeneralPractice 2013;63:69–75.•Moorhouse P. Screening for Dementia in Primary Care. The Canadian Review ofAlzheimer’s Disease and Other Dementias 2009.•Okura T, Heisler M, Langa KM. Association between cognitive function and socialsupport with glycemic control in adults with diabetes mellitus. Journal of the AmericanGeriatrics Society 2009;57:1816–24.•Palmer K, Bäckman L, Winblad B, et al. Mild cognitive impairment in the generalpopulation: occurrence and progression to Alzheimer disease. The American Journal ofGeriatric Psychiatry 2008;16:603–11.
  21. 21. Reading•Rasmussen J, Greaves I, Cartmell N, 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/620234 (accessed 7 Jan2013).•Richards M, Brayne C. What do we mean by Alzheimer’s disease? BMJ2010;341:c4670–c4670.•Satcher D. Mental health: A report of the Surgeon General. 1999.•Sontag S. Illness as Metaphor. New York: : Farrar, Straus and Giroux 1978.•Stephan BCM, Savva GM, Brayne C, et al. Optimizing mild cognitive impairment fordiscriminating dementia risk in the general older population. The American Journal ofGeriatric Psychiatry 2010;18:662–73.•Summerfield D. Depression: epidemic or pseudo-epidemic? Journal of the RoyalSociety of Medicine 2006;99:161–2.•TC R, JR M. Anti-dementia drugs for people with memory problems but withoutdementia. 2012.•UK National Screening Committee. The UK NSC policy on Alzheimer’s diseasescreening in adults. 2010.•Wilson JMG, Jungner G. Principles and practice of screening for disease. Public healthpapers 1968;34.•Brodaty H, Low L-F, Gibson L, et al. What is the best dementia screening instrumentfor general practitioners to use? The American journal of geriatric psychiatry : officialjournal of the American Association for Geriatric Psychiatry 2006;14:391–400.

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