In this “World Dementia Month” the Alzheimer’s Society have again highlighted the fact that the majority of people in this country with signs of dementia still go undiagnosed.
Here are their estimated figures for Britain:-
- 766,000 people thought to have dementia
- 311,000 with a diagnosis
- 455,000 with no diagnosis
These people and their families are left to cope with confusion, mood swings and depression in the sufferer. Furthermore, the carer – frequently an elderly partner -is left with no support, just a feeling of hopelessness. For many it is a matter of time before they become ill themselves.
The report goes on to criticise GP’s for failing to diagnose the condition earlier. Whilst this is understandable, it also needs to recognise that early diagnosis is not straightforward. There are many other health conditions, like depression or infection which have similar symptoms to early stage dementia. They need to be treated first and that in itself may not be quick and easy.
The next step usually requires a referral to a mental health consultant. This decision will not be taken lightly by the GP or the patient, because of the stigma attached to any mental illness. If they do get to that step, there currently is no physical test than can diagnose dementia. The best guess approach involves a set of simple everyday questions like “what date is it?”, “who is the Prime Minister?” , “who is the Queen of England?”, “what is in the news at the moment?”. This is called the “mini mental test” but it is far from a scientific way of condemning someone to a lifetime of decline with an incurable illness.
GP’s and consultants are well aware that there is little support available for people in the early stages of dementia, and until recently the drugs that that could be used, like Aricept, were not available on the NHS, because the National Institute for Clinical Excellence deemed them not to be cost-effective! Fortunately that decision has now been changed (see “A Confused Policy dated 28th July 2010 in the archive).
The other reason for hesitation is the awareness that in the long-term as the disease advances, there is little alternative to a placement in residential care, which is a prospect nobody welcomes.
I say all this, only to explain that a GP’s caution in diagnosing dementia is quite understandable, but it is not acceptable to leave the situation like this.
My next week’s dementia blog, ” Early Dementia Test”, points to a more scientific way of predicting early stage dementia. The sooner that this is used more widely, the sooner patients can be given drugs like Aricept, which at least slows down the progression of the illness and gives sufferers and their families a better quality of life for longer.
More accurate early diagnosis and a prospect of help, at least removes some of the fear for the future. Much more needs to be done beyond this.