Dementia is a progressive and largely irreversible clinical
syndrome that is characterised by a widespread impairment of mental function.
This includes problems with memory loss, thinking speed, mental agility,
language, understanding and judgement.
Dementia is a common condition that affects about 800,000 people in the
UK. The risk of developing dementia increases as you get older, and the
condition usually occurs in people over the age of 65.
Throughout the world there has been a ‘political drive’ to
assess elderly patients for Dementia, due to the large amount diagnosed and past
neglect of services and research in dementia has fuelled international calls
for action and earlier treatment. The Alzheimer’s Society estimated that in
2005 there were 574,717 people in England with dementia. In addition the
Society estimated that the total cost of dementia in the wider UK population
totalled £17.03 billion, or an average of£25,472 per person with late-onset
dementia. The NHS bears 8% £1.36 billion or £2.69 million per 100,000
population) of this total cost, as shown below.
The cost of £25,475 per person with late-onset dementia is
the primary reason for the demand for screening or case finding of mild
cognitive impairment and dementia, in aim to reduce NHS costs. In England, the
government has announced that it will reward GP’s around £3600 annually, per
practice for assessing patients aged over 75.This also includes those in a
‘at-risk group’ which is those patients with established diabetes or vascular
disease. People with diabetes have an increased risk of developing dementia,
due to high blood glucose concentrations which damage blood vessels, and the
risk of vascular dementia increases with blood vessel damage. This is also
being enforced in other places around the world such as in the United States,
under the new Affordable Care Act which is a recent new health reform, the
Medicare insurance programme will cover an annual wellness visit with a
physician. This wellness visit will include detection of cognitive impairment
or any measurable change in thinking abilities.
This screening process aiming to diagnose patients early
will beneficial so healthcare assistants can give counselling and provides an
opportunity for patients to organise financial affairs and future guardianship
whilst they are still competent.
However the ‘political drive’ is controversial, because
screening is not recommended by the UK National Screening Committee, Royal
Australian College of General Practitioners guidelines or the US Preventative
Services Task Force. This is
because there is no evidence for the usefulness or curative pharmacological
intervention. A further reason is that only 5-10% of people with mild cognitive
impairment progress to Dementia, therefore costs of screening may not outweigh
the costs of early diagnosis. Furthermore many people who develop dementia do
not meet the definitions of mild cognitive impairment before diagnosis. Also
very interestingly, research has shown that the development of people with
dementia is higher in people who don’t have symptoms of mild cognitive
impairment than in those who do. A major issue created by screening, is adding
increase risks to the patients: this is because there is no drugs to prevent
the progression, many patients turn to therapies such as Vitamin E,
cholinesterase inhibitors or memantine. These can increase damage to a
patient’s health rather than improve it, for example cholinesterase inhibitors
increase of hip fractures, syncope and pacemaker insertion.
It is difficult to assess whether the beneficial advantages
of screening patients for cognitive impairment outweighs the negative risks and
effects of the treatment. Nevertheless, within the UK and the US and many other
places around the world they think it’s extremely worthwhile.
Reference:
http://www.mayoclinic.com/health/vascular-dementia/DS00934/DSECTION=risk-factors
No comments:
Post a Comment