Political drive to screen for pre-dementia

A considerable number of rapid-responses followed this ‘AnalysisEditorial in the ‘Too Much Medicine‘ section of the BMJ. The following is my response of 14 September 2013:

I congratulate the authors (1) for presenting what has for far too long been missing in “consensus” discussions on cognitive changes as we get older.

It does not follow that a diagnosis is always to be viewed as a “curse” (as used in a sub-heading by the authors) but I certainly do agree that over-diagnosis and mis-diagnosis have the potential to be. This may especially be the case in our elders who may be frightened to complain or ask questions of medical authority (2).

Language used in this area, indeed in all areas of medicine, is important. Surely it is time to stop using military metaphors (war, fight, targets etc); metaphors around epidemics (burden, killer); and metaphors based on maps (pathways, signposts etc). This is also my concern with the word “curse”.

In this week’s online BMJ are three excellent blog posts by William Cayley (3), Leana Wen (4), and Edward Davies (5). They substantially add further to this important evidence-based analysis on memory loss in age by Professor Le Couteur.

(1) David G Le Couteur, Jenny Doust, Helen Creasey, Carol Brayne. Political drive to screen for pre-dementia: not evidence based and ignores the harms of diagnosis. Published 9 September 2013. BMJ2013;347:f5125

(2) Manthorpe, J. From forgetfulness to dementia: clinical and commissioning implications of diagnostic experiences. Br J Gen Pract 2013; 63: 30–31

(3) Cayley, W. Does uncertainty and fear of the unknown drive overdiagnosis?

(4) Wen, L. Where to begin the conversation on overdiagnosis.

(5) Davies, E. Overdiagnosis—what are we so afraid of? 

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