Why doctors say catching dementia early may not be as beneficial as you think

In discussions about dementia, a commonly heard notion is the significance of early detection.

It might be assumed that with earlier detection, patients and their families would have additional time to prepare and strategise for the effects of dementia.

Nevertheless, distinguished scholars have provided insights that challenge this idea.

Professors Steve Iliffe, professor emeritus of primary care for older people at University College London and King’s College London Professor Emerita of Social Work Jill Manthorpe argue that due to the lack of reliable and safe treatments for dementia, it is ethically inappropriate to screen entire populations, considering the lack of viable treatment options.

Instead, they advocate for a greater emphasis on prevention.

‘Timely recognition—when an explanation can be given for distressing memory loss, anxiety, depression or agitation—might bring relief to individuals and their families, but this does not justify the diversion of resources to diagnosis campaigns,’ they said in a column on The Guardian.

Illife and Manthrope said local variations in how different authorities recognise dementia should come as no surprise.

Dementia comprises a range of symptoms influenced by various risk factors throughout a person's life, which include genetic predisposition, age, cardiovascular health, and lifestyle factors such as smoking and physical inactivity.

Dementia affects the lives of over 400,000 Australians, and a similar number of individuals are engaged in their caregiving. Image source: Pixabay

While disparities in access to scanners might exist, they only play a minor role in timely dementia recognition.

‘Scanners are expensive and need a new workforce to service them,’ the pair said.

‘Much more work would be needed to establish the “right” number of scanners and to recruit a new workforce for them.’

Illife and Manthorpe then presented a thought-provoking point: the push to catch dementia early on doesn’t warrant diverting resources to diagnosis campaigns.

When there are calls for more memory clinics or increased technology, it’s crucial to question the proposed trade-offs of prioritising treatment over prevention.

‘Prevention of dementia through public health approaches is one area where investment is sorely needed,’ they said.

Dementia affects over 400,000 Australians, making it the second leading cause of death in the country, but unfortunately, there is currently no cure available.

The University of Melbourne leads the Australian Dementia Network (ADNeT), supported by various organisations, in a mission to combat dementia.

This partnership involves 17 top Australian universities, research institutions, and individuals with dementia experience, focusing on three key initiatives:

  • The clinical quality registry, assesses the quality of diagnosis and care for those newly diagnosed with dementia or mild cognitive impairment. This initiative aims to improve clinical care standards.
  • Development of best practice guidelines for dementia diagnosis and treatment in Memory Clinics. These guidelines ensure quality care access for individuals with dementia, regardless of location.
  • Screening and trials to identify suitable patients for clinical trials aimed at developing effective therapies for dementia.

Despite the current absence of a cure, early detection plays a crucial role in dementia, particularly for Alzheimer's disease.

ADNeT is dedicated to supporting early diagnosis and research, focusing on amyloid and tau proteins in Alzheimer’s.

They lead in using blood-based biomarkers for earlier, less invasive, and more accessible diagnosis, closely monitoring new Alzheimer's treatments.

This initiative, funded by the National Health and Medical Research Council and supported by various partners, marks significant progress in improving the lives of Australians with dementia.

Video source: YouTube/Dementia Australia

Key Takeaways

  • Local authority variations in the recognition of dementia are not surprising due to the influence of multiple risk factors over someone's life.
  • Scanners, while important, play only a small part in the timely recognition of dementia and require significant resources and a workforce to operate.
  • Assumptions about the benefit of early recognition are often made, however, without effective and safe treatment for dementia, screening can be seen as ethically wrong.
  • The authors argue that investment in prevention through public health approaches is more needed than resources being diverted to diagnostic campaigns.
  • The University of Melbourne has partnered with 17 prominent Australian institutions to help individuals living with dementia.
Members, what do you think of this story? Let us know your thoughts in the comments below!
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Reactions: PattiB and Sockjoan
My late husband died with dementia (Alzheimer’s). His GP sent him for a brain scan, which showed shrinkage of the brain. He then went to a geriatrician, who put him on a drug to slow the progression. It was five-and-a half years from diagnosis to death. I’m not sure if it was the Alzheimer’s that killed him; near the end, he fell out of bed several times, and hit his head. The last time this happened he was sent to hospital; the hospital scanned his hips, as a broken hip would be painful (and he could no longer speak to say if he was in pain), but they wouldn’t scan his head for a brain bleed because they said the machine would terrify him (true) and they wouldn’t do anything about it anyway. My opinion is that it was some sort of stroke (cerebral haemorrhage). The hospital told me he had days to live, or just possibly weeks; I told them to please send him straight back to his nursing-home, where he’d be in familiar surroundings and among familiar people. He died a week later.
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What exactly is early dementia?? Has this been clinically documented? Is it a condition common to both men and women? Are there known indicators as to the onset? Is hearing impairment a crucial factor in recognizing dementia? It seems that there is no unified recognition on the onset and then its progression. Is it because we are all so different ? Or does the medical profession still not know? Does it simply come down to doctors relying willy nilly on individual symptoms?
If the government got rid of fluoride in the water, it is very liekly that there would not be so many casese of dementia. There is scientific evidence that it affects the brain on some people.

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