The pros and cons of early diagnosis in dementia.

Dementia is an undeniable concern for ageing societies. If the predicted increases in life expectancy continue unabated, this will lead to a near doubling of the numbers of people with dementia in the UK within a quarter of a century,1 with a doubling of numbers expected every 20 years globally.2 The challenge this ‘failure of success’ poses has only relatively recently been fully recognised at the societal level. In 2012 the US announced a national Alzheimer’s plan to prevent and effectively treat dementia by 2025, provide higher quality care, provide more support for patients and their families, enhance public awareness and engagement, and deliver improved data collection to understand its impact.3 In the UK this attention has led to first a highly influential stocktaking of dementia in the UK,4 stimulating governmental recognition of the importance of dementia and to the Prime Minister’s Dementia Challenge. The areas of focus are those in which the government and their advisors perceive to be tractable and which may stimulate economic benefit through innovation, trying to create positive outcomes from a condition that is generally held as a tragedy. The many awareness campaigns have been perceived to be successful, although the consequence of heightened population awareness, particularly for those in later life, has also been rising fear. This has been fuelled by the use of estimates based on true population-based studies to support the widely-stated estimates of the proportions of people living in the community with ‘undetected’ dementia or ‘cognitive impairment’, since these are larger numbers than those known to the appropriate caring agencies. One of the results of this societal fear, as with cancer, is an emphasis on what can be done to prevent and detect the ‘disease’ earlier. Unfortunately, dementia is not a disease but a syndrome. The clinical …