Dementia Screening: Part I of 2

Contributed by: Dennis Fortier, President, Medical Care Corporation

I like to support clear steps in the right direction, but I have mixed feelings about the Alzheimer's Society recommending that physicians screen their patients for dementia beginning at age 75.

Granted, it is difficult for even the greatest physicians to address additional health concerns, outside of those that brought the patient to the clinic, during a typical visit.  The structured nature of most health care interactions simply does not allow enough time for such exploratory activity.  Since few patients visit a physician about a memory or cognition concern, until the problem is severe,  most early stage problems are never addressed in primary care.

This leads to very late detection of cognitive problems and poor treatment outcomes based on late intervention.  From that perspective, the Alzheimer's Society has taken a laudable approach to improving care.

However, my problem with their recommendation is that it hinges on the term dementia, which refers to a state of such severe impairment, that a patient is no longer able to care for themselves without human assistance.  Even the term "early dementia" means that the threshold of severity has been crossed, and the patient's cognition is so poor that it has hampered their ability to function in daily activities.  For most patients, and most causes of dementia, this is likely to be too late for meaningful intervention.

To improve care and keep our aging population cognitively intact, we need to detect more subtle symptoms so as to treat the underlying causes before a person becomes demented.  This is the only way to preserve "high quality of life" and to contain the exorbitant costs associated with caring for demented populations. 

Excellent tools for evaluating cognitive health and for detecting subtle signs of decline are available to primary care physicians.  Contrary to the statement in the BBC article to which this post is linked,  these assessments take only a few minutes and fit soundly within the logistics of a primary care practice.

I applaud all efforts to encourage the evaluation of memory and cognitive function in the physician's office, but I emphasize that these efforts must focus on detecting problems early enough to treat them effectively.

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