In this Royal College of Psychiatry debate it was agreed beforehand that Prof Ballard could present first.
The debate centred on this RCPsych Motion: “This house supports the early detection of dementia”.
This meeting was not recorded for archive, though the organisers have since asked if “presentations” might be shared.
In what follows is my best (yet naturally rushed) capture of Prof Ballard’s argument. It may be that Prof Clive Ballard accepts the opportunity to display all his slides and associated words for the public.
Here is what I heard and recorded of Prof Ballard’s riposte:
Prof Ballard gave no declarations of interest in either the programme or on any slide. He did not mention any potential conflicts during his talk.
Whilst I understand the meeting was partly sponsored by LILLY it is not the case that any of the speakers on the day were paid for talks
Prof Ballard’s presentation:
First slide: “90% of people want an early diagnosis” (AD International, 2011)
First Slide: would seem to conflate: “early dementia” with “mild Alzheimer disease” and Prof Ballard continues to use these terms interchangeably throughout his argument.
First Slide: “50% of people never diagnosed” then elaborates with “Alzheimer Society Map” … “still only 46% diagnosed” thus “54% with dementia, 42800, are un-diagnosed”
Professor Clive Ballard: “Early Alzheimer’s disease: we should be diagnosing at this stage”
Prof Ballard gave no definitions at all at any time in his full argument today
Prof Ballard then moved on to talk of drug benefits: Cites RICHIE, CW et all, 2004
Prof Ballard stated at this talk that “anti-dementia drugs” [bring] “significant benefit for mild to moderate Alzheimer’s disease”. Prof Ballard mentions NICE.
Prof Ballard: “Alzheimer’s disease is a terminal illness with just 4 years to live.”
Prof Ballard: Combining acetylcholinesterase inhibitors with memantine “much better outcome” ATRI et al, 2008
Prof Ballard cites DOMINO study to support acetylcholinesterase inhibitors as “anti-dementia” drugs with “significant” effects [pers thought was I wonder what Jim Thornton would make of this? see: http://ripe-tomato.org/2012/04/24/memantine-andor-donezepil-for-moderate-alzheimers/
Prof Ballard said at this conference that for “mild Alzheimer’s disease a new generation of further symptomatic treatments are now coming available”
Prof Ballard finishes by stating his view that we should be diagnosing pre-clinical dementia and that services should now be offering the early diagnosis of “mild Alzheimer’s disease”. Prof Ballard said we should allow all “patients” to choose this option if they wish and that this is the basis of “informed consent and choice”…. and that “we should present this choice”. At no point in his ten minute argument or in his riposte did Prof Ballard mention potential harms of such an approach. Professor Ballard presented only potential benefits.
Prof Ballard stated that “we should not be consigning people to annual follow up as most people do not want such uncertainty”
Prof Ballard concluded his riposte: “I would say a timely diagnosis is the same as early diagnosis”