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

1. Dementia Screening
Welcome!
While you’re finding your seats, please
consider the following question:
What are the needs of patients with
dementia, their families and carers?

2. Dementia Screening
Annual symposium of
RCGP Thames Valley Faculty
30 April 2013
John 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. Background
Prime 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 with
dementia, their families and carers?
•Support
•personal care
•emotional support
•carer support
•financial (benefits)
•Signposting

6. What are the needs of patients with
dementia, their families and carers?
•Advance planning
•Lasting power of attorney
•Equipment
•Memory aids

7. What are the needs of patients with
dementia, their families and carers?
•Treat reversible causes
•Effective treatment
•Manage comorbidities
•Reduce stigma

8. What other benefits might a dementia
screening programme have?
•Prevalence (determine & increase)
•Establish need for resources
•Raise priority for research

9. What are the risks of a dementia
screening programme?
•Medicalise ageing
•Disengagement of informal carers
•Opportunity costs
•those with health care needs but different or
no diagnosis
•diversion of resources from those in greatest
need

10. What are the risks of a dementia
screening 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 dementia
screening programme?
•Insurance
•Misperception of capacity
•family disharmony
•financial abuse

12. Who benefits from dementia
screening?
•Some patients/carers
•Primary care (£3000 for DES; LES)
•Secondary care
•Pharmaceutical industry
•Politicians
•Research

13. How to implement the DES
Which cognitive test?
•Quick
•High specificity
•Good sensitivity
Mini-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. Reading
GrassrootsGP.org/dementia-screening
Mendeley list
•John@DrCosgrove.net

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