RSS Feed Print
Are Dr's over-diagnosing memory problems?
llee08032
Posted: Wednesday, September 5, 2018 7:22 AM
Joined: 5/20/2014
Posts: 4406


Over-Diagnosis Summary

  • Clinical context—Dementia is age related and with an ageing global population is predicted to become an overwhelming and costly problem
  • Diagnostic change—Introduction of broader diagnostic criteria for mild cognitive impairment and pre-dementia based on new cognitive screening tests coupled with cerebrospinal fluid biomarkers and neuroimaging
  • Rationale for change—Past neglect of services and research in dementia has fuelled international calls for action and earlier treatment
  • Leap of faith—People with mild symptoms will eventually develop dementia and interventions are more likely to be effective at an early stage
  • Impact on prevalence—The current prevalence of dementia is thought to be 10-30% in people over the age of 80, but the adoption of new diagnostic criteria will result in up to 65% of this age group having Alzheimer’s disease diagnosed and up to 23% of non-demented older people being diagnosed with dementia
  • Evidence of overdiagnosis—Screening for cognitive impairment and measurement of biomarkers and neuroimaging are increasing the diagnosis of mild cognitive impairment, which in many people will improve spontaneously
  • Harms from overdiagnosis—Unnecessary investigation and treatments with side effects; adverse psychological and social outcomes; and distraction of resources and support from those with manifest dementia in whom need is greatest
  • Limitations—Current case identification and screening policy relies mostly on anecdotal and observational data from potentially biased sources, including those with vested commercial interests, rather than evidence from clinical trials. There is a lack of research focused on older people, in whom dementia is most prevalent
  • Conclusions—Current policy is rolling out untested and uncontrolled experiments in the frailest people in society without a rigorous evaluation of its benefits and harms to individuals, families, service settings, and professionals

llee08032
Posted: Wednesday, September 5, 2018 7:24 AM
Joined: 5/20/2014
Posts: 4406


Friday, August 31

Are Doctors Over-Diagnosing Memory Problems?

Diagnosis
DIAGNOSIS: Worried about minor memory changes? The British Medical Journal revealed how unnecessary memory screens lead to a 23% over-diagnosis rate. Learn the risks, harms and costs to individuals, families and societies.



The British Medical Journal is warning that a political drive to screen older people for minor memory changes is leading to unnecessary investigation and potentially harmful treatment for what is arguably an inevitable consequence of ageing.

Their statement coincided with the Preventing Overdiagnosis conference in New Hampshire, USA, partnered by BMJ’s Too Much Medicine campaign, where experts from around the world will gather to discuss how to tackle the threat to health and the waste of money caused by unnecessary care.

Avoid overdiagnosis A team of specialists in Australia and the UK say that expanding diagnosis of dementia will result in up to 65% of people aged over 80 having Alzheimer’s disease diagnosed – and up to 23% of non-demented older people being labeled with dementia.

They argue this policy is not backed by evidence and ignores the risks, harms and costs to individuals, families and societies. It may also divert resources that are badly needed for the care of people with advanced dementia.

Over-Diagnosis Summary

  • Clinical context—Dementia is age related and with an ageing global population is predicted to become an overwhelming and costly problem
  • Diagnostic change—Introduction of broader diagnostic criteria for mild cognitive impairment and pre-dementia based on new cognitive screening tests coupled with cerebrospinal fluid biomarkers and neuroimaging
  • Rationale for change—Past neglect of services and research in dementia has fuelled international calls for action and earlier treatment
  • Leap of faith—People with mild symptoms will eventually develop dementia and interventions are more likely to be effective at an early stage
  • Impact on prevalence—The current prevalence of dementia is thought to be 10-30% in people over the age of 80, but the adoption of new diagnostic criteria will result in up to 65% of this age group having Alzheimer’s disease diagnosed and up to 23% of non-demented older people being diagnosed with dementia
  • Evidence of overdiagnosis—Screening for cognitive impairment and measurement of biomarkers and neuroimaging are increasing the diagnosis of mild cognitive impairment, which in many people will improve spontaneously
  • Harms from overdiagnosis—Unnecessary investigation and treatments with side effects; adverse psychological and social outcomes; and distraction of resources and support from those with manifest dementia in whom need is greatest
  • Limitations—Current case identification and screening policy relies mostly on anecdotal and observational data from potentially biased sources, including those with vested commercial interests, rather than evidence from clinical trials. There is a lack of research focused on older people, in whom dementia is most prevalent
  • Conclusions—Current policy is rolling out untested and uncontrolled experiments in the frailest people in society without a rigorous evaluation of its benefits and harms to individuals, families, service settings, and professionals

Dementia is age related and with an ageing population is predicted to become an overwhelming and costly problem. But the evidence suggests that while 5 - 15% of people with mild cognitive impairment will progress to dementia each year, as many as 40 -70% will not progress and indeed their cognitive function may improve. Studies also show that the clinical tools used by doctors to diagnose dementia are not robust, and that many people who develop dementia do not meet definitions of mild cognitive impairment before diagnosis. But this has not deterred countries from developing policies to screen for pre -dementia.

For example, in the US, the Medicare insurance programme will cover an annual wellness visit to a physician that includes a cognitive impairment test. In England, the government has announced that it will reward general practitioners for assessing brain function in older patients – and has committed to have “a memory clinic in every town and every city” despite no sound evidence of benefit.

This had led to the development of imaging techniques and tests that are increasingly used in diagnosis, despite uncertainty over their accuracy, say the authors. The researchers say however, that until such approaches are shown to be beneficial to individuals and societies they should remain within the clinical research domain.

Furthermore, there are no drugs that prevent the progression of dementia or are effective in patients with mild cognitive impairment, raising concerns that once patients are labelled with disease or pre-disease, they may try untested therapies and run the risk of adverse effects.

They also question whether ageing of the population is becoming a “commercial opportunity” for developing screening, early diagnosis tests and medicines marketed to maintain cognition in old age.

The desire of politicians, dementia organisations, and academics and clinicians in the field to raise the profile of dementia is understandable, write the authors, “but we risk being conscripted into an unwanted war against dementia.”

They suggest that the political rhetoric expended on preventing the burden of dementia would be much better served by efforts to reduce smoking and obesity, given current knowledge linking mid-life obesity and cigarettes with the risk of dementia.

“Current policy is rolling out untested and uncontrolled experiments in the frailest people in society without a rigorous evaluation of its benefits and harms to individuals, families, service settings, and professionals,” they conclude.

Misssy2
Posted: Saturday, September 22, 2018 9:49 PM
Joined: 12/14/2017
Posts: 1721


I don't think they are over diagnosing I think that they have better technology and understanding....

My PET Scan was clear biochemical evidence of a brain that is functioning at a level that is suggestive of a type of pre frontal dementia.

So if they took a picture of someone elses brain...it has "normal" activity where mine does not.

I don't know how they would over-diagnose with bodily fluids and brain scan evidence.

Prior to having my PET Scan she told me not to feel bad if it came out normal for "normal aging" and that she has seen much concern also of late....with people worrying about their memories because of a family member.

Which my Dad has LBD but I was asking for help long before my Fathers dementia started to show...or was diagnosed...I just ended up going to her for a second opinion because others did not go this far with the testing...they brushed my problems off to anxiety.

So I think if there are tests that say someone has dementia...than they have it.

I don't think they WANT to diagnose this with anyone.


jfkoc
Posted: Sunday, September 23, 2018 11:38 AM
Joined: 12/4/2011
Posts: 17539


Diagnosing a memory problem is one thing. It is the next step, finding the cause, that I fear is not being done.
Andrew60
Posted: Monday, September 24, 2018 9:24 AM
Joined: 7/17/2017
Posts: 342


Interesting articles, thanks for posting.

I was under the impression that many Drs are adraid to tell the patient they have whatever type of dementia? So, this information on over diagnossing has me searching again for answers.

My first Neurologist even told me he does not like to inform patients that they have dementia because of the stress it will cause them. Then, 3 months later, he prescribed aricept for me, even though he said I only have amnestic MCI.


AnnaS
Posted: Tuesday, September 25, 2018 8:10 PM
Joined: 9/25/2018
Posts: 6


My sister, I feel so helpless. I think she may have been over diagnosed. She is married and children living close to her. It seems the meds have made her worse. I am the only o e that thinks this. The first time she got lost driving, the family (not me) pulled her driving. I feel like she is isolated and that is making it worse. She is bored. Not working. I wish she could volunteer somewhere. She lives animals and children. Is there a program where she can work with both.

I should add, this has been going on for at least 10 years and she is now 60. She is a person who did drink alcohol too much. One psychiatrist identified this. But, she got mad at him and stopped going. Then the family was somehow directed to neurologists who deals memory. First doctor said she had PPA. The primary issue is her speech. Thrn 6 months later, that dr. Had left and the next one said no, she has Alzheimer’s. Same institution , 2 different doctors. I am so upset and feel helpless. The rest of family is tellin me I have my head I. The sand. 


dolor
Posted: Tuesday, September 25, 2018 9:25 PM
Joined: 11/9/2017
Posts: 308


Anna, your situation sounds very hard. Do you know what medications she is taking? If the primary problem is her speech and less her memory, it could even be the medication. Certain meds for seizures and/or nerve pain can cause speech problems (and some forgetfullness for that matter). Neurontin and Topamax are two examples. 

She could possibly have one of the other dementia diseases. Fronto-temporal dementia can affect speech before memory. It sometimes shows personality and behavior changes too. Too many drs jump immediately to Alzheimers, and medications for one of the diseases can be counterindicated for another. 

You might want to google her medications for side effects, and then google "dementia diseases." You may have to be the advocate; I wouldn't advise leaving it up to the doctor... 

Best wishes for your sister. 


AnnaS
Posted: Tuesday, September 25, 2018 9:29 PM
Joined: 9/25/2018
Posts: 6


I agree. How many people experience what appears as Alzheimer but the cause may be different. I just do not get a warm fuzzy feeling about it....seems like there is a lot of room for error and unnecessary suffering.
AnnaS
Posted: Tuesday, September 25, 2018 9:30 PM
Joined: 9/25/2018
Posts: 6


Thank you. I hope people begin to get 2nd and 3rd opinions
AnnaS
Posted: Wednesday, September 26, 2018 10:18 AM
Joined: 9/25/2018
Posts: 6


Thank You so much...
Mimi S.
Posted: Wednesday, September 26, 2018 11:46 AM
Joined: 11/29/2011
Posts: 7035


Anna That is why it is so important that one go to the proper place for a good diagnosis. this is usually a large University or Medical complex.  From one's library, ask for any book by Doraiswamy and Gwyther  This is the process that MUST be done before any diagnois can be believed  A diagnosis from a mini-mental test is worthless.
AnnaS
Posted: Saturday, October 6, 2018 12:20 AM
Joined: 9/25/2018
Posts: 6


Thank You so much
AnnaS
Posted: Saturday, October 6, 2018 12:27 AM
Joined: 9/25/2018
Posts: 6


She was diagnosed at Massachusetts General Hospital. But, I just am not convinced they diagnosed her properly. I have asked my brother-in-law (her husband) and my niece (her daughter) to let me go to one of the appointments with them  at Mass General. They told me it is what it is and I just have to believe the diagnosis. I think I am going to tell them, she is my sister toosnd everyone has Ben to an appointment w the doctor except me and tell them I need to ask my questions to the doctor. I can help them so much more if I got to meet the doctor. But without a contact I am just following family orders. I am very frustrated