Screening for early indicators of dementia and other cognitive decline does more harm than good, according to a group of dementia and geriatric medicine experts. In a new editorial published in the journal BMJ, the researchers argue that the practice is driven by profit motives, and that certain diagnoses needlessly come to the detriment of patients whose symptoms won’t progress. For many patients, the stigma of nascent cognitive impairment affects everything from insurance to employment, irrespective of the condition’s actual characteristics and prospects.
In light of the inclusion of cognitive testing in annual “wellness” screenings under the U.S. Patient and Affordable Care Act, specialists caution that countless individuals will soon run the risk of receiving irrelevant, superfluous, or exaggerated diagnoses. The practice, they said, originates in the false assumption that mild cognitive impairment will invariably progress to dementia and other more severe symptoms over time. However, research indicates that 40 to 70 percent of people with mild symptoms do not experience further cognitive decline.
Given the fact that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) now describes modest deviations as “minor neurocognitive decline,” 16 percent of the population stands to receive a diagnosis, MedPage Today reported.
"The desire of politicians, dementia organizations, and academics and clinicians in the field to raise the profile of dementia is understandable, but we risk being conscripted into an unwanted 'war against dementia',” they wrote, adding that nearly half of the patients who receive a positive result in a screening for cognitive impairment refuse subsequent evaluation. Fearing loss of driving privileges, insurance, or employment, many choose to distance themselves from the diagnosis.
Aside from financial losses, the screenings may also promote needless emotional suffering and changes in lifestyle.
"The diagnosis of dementia-related illness affects identify, leading to feelings of loss, anger, uncertainty, and frustration,” the researchers explained. “It also affects roles and relationships within the family and in wider social networks. The distress of getting a diagnosis may also result in suicide or euthanasia."
Instead, treatment efforts and policies should target individuals living with advanced stages of cognitive decline. Today, more than 5 million American suffer from Alzheimer’s disease and other types of severe dementia. Future research should focus on risk factors like obesity and smoking rather than new methods of diagnosis, they specialists said.