Date Published: August 8, 2017
Author(s): Larry W. Chambers, Saskia Sivananthan, Carol Brayne.
Despite efforts to raise awareness and develop guidelines for care of individuals with dementia, reports of poor detection and inadequate management persist. This has led to a call for more identification of people with dementia, that is, screening individuals who may or may not complain of symptoms of dementia in both acute settings and primary care. The following should be considered before recommending screening for dementia among individuals in the general population. Dementia Tests. Low prevalence reduces positive predictive value of tests and screening tests will miss people who have dementia and identify people who do not have dementia in substantial numbers. Clinical Issues. The clinical course of dementia has not yet been shown to be amenable to intervention. Misdiagnosis and overdiagnosis can have significant long-term effects including stigmatization, loss of employment, and autonomy. Economic Issues. Health systems do not have the capacity to respond to increased demand resulting from screening. In conclusion, at present attention to life-course risk reduction and support in the community for frail and cognitively impaired older adults is a better use of limited healthcare resources than introduction of unevaluated dementia screening programs.
Dementia is a condition with multiple causes that affects memory, other cognitive abilities, and behaviour that interfere with a person’s ability to drive, deal with their finances, manage their healthcare, and live independently . Also, dementia has a significant impact not only on individuals but also on their careers, families, communities, and societies .
The local Alzheimer Association requested advice from the local medical society to introduce an awareness raising campaign to screen for dementia. Practitioners often see individuals who once diagnosed have a clear view that their delay in accessing support and advice from services have caused harm and that this can be remedied by systematic screening. They feel that early detection and remediation could lead to improved quality of life for affected individuals and their caregivers. The Alzheimer Association states that their supports and other activities are available for any individuals with identified problems. They believe that making the test results known to caregivers and the Association will assist individuals when identified early. Many jurisdictions have begun such campaigns and are enthusiastic about them. Concerned caregivers in your community are encouraging the Alzheimer Association to follow suit. You are part of a committee asked by the medical society to prepare an answer. Your report will be due next week.
Public resources are involved in this decision. Funding used for one activity is not then available for another. Deciding to screen or not should therefore be based on explicit criteria. A collection of previous experiences and the evolution of rules of evidence about screening  were fused into the three following areas: testing, clinical decisions, and economic considerations. These criteria can be used to determine, on the basis of current evidence, whether screening causes more harm than good in individuals who have not sought medical attention. The rest of this article will describe these and show how to use them when appropriate for a given population (Table 1).
The medical society group that was advising the local Alzheimer Association about the proposed community wide awareness campaign on dementia screening examined the evidence about the links of “apparently healthy” individuals. It concluded that there were few interventions of rigorously demonstrated efficacy for the symptoms of dementia that would be detected among apparently healthy individuals, and there was no acceptable evidence that the early detection of most of the symptoms of dementia altered their prognoses. The required studies simply had not been done indicating the need for more research on the six questions outlined in this report.