Patients could be missing out on early treatment options for dementia because general practitioners (GPs) are failing to diagnose the condition early enough, according to new research.
Moreover, survival rates are much lower for patients whose dementia is diagnosed by their GP than for those who are actively screened for the condition in research studies, says the study, which was conducted by scientists at the Medical Research Council (MRC) and is the first of its kind to analyse life expectancy after dementia is recorded by GPs.
Once their GP has diagnosed dementia, average life expectancy for patients aged 60-69 is 6.7 years, according to the research, which was published this month in the British Medical Journal (BMJ). Previous research by MRC scientists has shown that people in a comparable age range, actively screened for dementia as part of a research study, have a life expectancy of 10.7 years. The findings also show that mortality rates are more than three times higher in people with dementia in the first year after GP diagnosis than in those without dementia, and the researchers suggest that this indicates GP diagnoses were made at times of crisis or much later in the lifecycle of the disease.
“Until now, most survival estimates have come from studies where people have been actively screened for dementia, but the reality is that medical care for dementia patients tends to fall with family doctors,” commented the MRC's Greta Rait, who led the study.
“GPs are going to be dealing with more and more dementia cases in future, and primary care must get better at detection. It’s therefore essential we conduct reviews and research like this,” said Dr Rait, who added that the new study’s findings “will help clinicians to make more realistic estimates of life expectancy for patients when they are diagnosed and also assist policymakers in planning services.”
Christopher Kennard, chair of the MRC Neuroscience and Mental Health Board, said it is clear that “too little too late” is being done to diagnose dementia and he warned that, without earlier diagnosis, people may miss out on the opportunity to have early interventions as new treatments come along.
“It’s estimated that 80 million people worldwide will be affected by dementia by 2040, so it’s crucial GPs are given the support and training they need to get to grips with identifying dementia accurately and as early as possible. The NHS has recently launched a national strategy for dementia and gave £150 million over five years, which will enable the establishment of memory clinics throughout the country to aid the early diagnosis of dementia. The findings of the research strongly support this approach,” added Professor Kennard.
The study - which analysed the health records of over 135,000 people aged 60 years or over from more than 350 UK practices during 1990- 2007 - also found that GPs were recording dementia in a non-specific way; they were not differentiating between Alzheimer’s disease and vascular dementia. This has implications for managing the disease over the long term, the scientists caution, but they also suggest that improvements could be made with training and incentives.
- Dementia affects about 570,000 people in England alone. At the current rate, the number of people with the condition will double in the next 30 years and the cost to the nation will rise from £15.9 billion at present to £34.8 billion by 2026, the National Audit Office (NAO) has estimated. A report published in January by the NAO welcomed Living Well with Dementia, the Department of Health’s strategy for the condition introduced in February 2009, but said there had yet to be a “robust approach” to implementing this “ambitious and comprehensive” initiative.
The strategy had not yet been given the “levers or urgency normally expected for such a priority and there is a risk that value for money will remain poor unless these weaknesses are addressed urgently,” the NAO warned.