This new 70-page report from Alzheimer’s Disease International warns that in countries such as England, 50-80% of dementia cases are not being recognised in primary care. It highlights the fallacy that as people get older they naturally have problems with their memory, and goes on to recommend that primary care staff who see people with signs of mild cognitive impairment should consider referring them for assessment by a memory clinic.

The key findings from the report are:

• Dementia diagnosis provides access to a pathway of evidence-based treatment, care, and support across the disease course
• Perhaps as many as 28 million of the world’s 36 million people with dementia have yet to receive a diagnosis, and therefore do not have access to treatment, information, and care
• The impact of a dementia diagnosis depends greatly upon how it is made and imparted. Evidence suggests that when people with dementia and their families are well prepared and supported, initial feelings of shock, anger and grief are balanced by a sense of reassurance and empowerment
• Earlier diagnosis allows people with dementia to plan ahead while they still have the capacity to make important decisions about their future care. In addition, they and their families can receive timely practical information, advice and support. Only through receiving a diagnosis can they get access to available drug and non-drug therapies that may improve their cognition and enhance their quality of life. And, they can, if they choose, participate in research for the benefit of future generations
• Most people with early stage dementia would wish to be told of their diagnosis
• Improving the likelihood of earlier diagnosis can be enhanced through
• medical practice- based educational programs in primary care
• the introduction of accessible diagnostic and early stage dementia care services (for example, memory clinics)
• promoting effective interaction between different components of the health system
• Early therapeutic interventions can be effective in improving cognitive function, treating depression, improving caregiver mood, and delaying institutionalisation. It is simply not true that there is ‘no point in early diagnosis’ or that ‘nothing can be done’. Some of these interventions may be more effective when started earlier in the disease course
• Available evidence suggests that governments should ‘spend to save’ – in other words, invest now to save in the future. Economic models suggest that the costs associated with an earlier dementia diagnosis are more than offset by the cost savings from the benefits of anti- dementia drugs and caregiver interventions. These benefits include delayed institutionalisation and enhanced quality of life of people with dementia and their carers.

Marc Wortmann, Executive Director of Alzheimer’s Disease International, said:

Over the past year, the research team has reviewed thousands of scientific studies detailing the impact of early diagnosis and treatment, and we have found evidence to suggest real benefits for patients and caregivers. Earlier diagnosis can also transform the design and execution of clinical trials to test new treatments. But first we need to ensure that people have access to the effective interventions that are already proven and available, which means that health systems need to be prepared, trained and skilled to provide timely and accurate diagnoses, communicated sensitively, with appropriate support.

Professor Martin Prince of the Institute of Psychiatry, King’s College London, and main author of the report added:

What is clear is that every country needs a national dementia strategy that promotes early diagnosis and a continuum of care thereafter. Primary care services, specialist diagnostic and treatment centers and community-based services all have a part to play, but to differing degrees depending upon resources.

Department of Health has recently pledged to invest £10 million in memory services to identify people with dementia earlier and treat them more effectively. Care Services Minister, Paul Burstow said:

While there is no cure for dementia, we know that early diagnosis and early intervention can help people take control of their condition and plan for the future. With access to the right services and support, people with dementia can continue to live well for many years. Memory services have a really important role to play in this.

World Alzheimer report 2011: the benefits of early diagnosis and intervention (PDF). Alzheimer’s Disease International, Sep 2011.