The use of wide-scale mental agility testing to identify people at risk of dementia: crucial or harmful?

The prevalence of dementia in the UK is rising rapidly and is predicted to double over the next 30 years. The NHS in England has been told to push for a rapid rise in dementia diagnosis rates, so that by 2015, two out of three cases are identified. The Prime Minister has raised the ‘dementia challenge’ as a priority for the NHS. While there is agreement on the need for action, debate arises over the nature of that intervention. Some, including Professor Alessi, argue that tools exist to support the diagnosis of mild cognitive impairment and they should be used because the disease is amenable to interventions. He believes that we need a shift in knowledge and attitude from thresholds to a continuum of cognitive impairment, from late to early stages and from effects to causes. The Montreal Cognitive Assessment (MoCa) should become part of the routine NHS Health Check after people reach age 40. Dr Fox argues on the other hand that widespread testing could lead to unnecessary anxiety and panic among those at risk and that funding should be focused on learning more about the early stages of dementia. While the concept of early testing is appealing, there is a large knowledge gap; instruments in use have not been tested in pre-dementia patients and have limited validity. While there is debate over the approach, we can agree that the economic and social impacts of this condition need to be addressed sooner rather than later.

KEYWORDS Diagnosis, prevention, testing, dementia

DECLARATIONS OF INTERESTS Dr Fox is part of an NHS England task force on improving diagnosis. He is also a coordinator of a Medical Research Council prevention and screening platform in dementia research group. Dr Fox was funded by the Alzheimer’s Society for a systematic review on screening in dementia. Dr Alessi is the lead on preventable dementia for Public Health England. Dr Ahluwalia reports he will be a co-applicant on a grant request to the NIHR (to be submitted) looking to study the role of vascular risk factor modification on dementia prevention.