In what looks like an Alzheimer’s Society inspired press release, the NHS is urging us to look for signs of dementia in our older relatives as we come together for Christmas. It says that the things to look for are emotional change, forgetfulness, difficulty concentrating. struggling to follow a conversation or find the right word, being confused about time and place.
It’s part of a drive to increase diagnosis rates, with 14 pilots across England seeing health professionals go into care homes to assess older adults who may have missed checks during the pandemic.
The press release says that Heath chiefs are expecting the ambition of diagnosing 66.7% of people over 65 will be met in the next year, with three regions already hitting the target in London, North West, and North East and Yorkshire. It adds that, ‘NHS has also set up a dedicated programme to prepare for the rollout of new drugs that could slow the progression of early Alzheimer’s Disease, if they are approved by regulators, and this includes assessing additional testing requirements and capacity.’
It begs two questions: why the push to diagnose more people with dementia when very little support is available to them and their families and only a few medications help with symptoms?
Talk of treatment to hold back the progress of the disease is premature, with controversy surrounding the new ‘breakthrough’ drugs and America’s Medicare insisting that prescribers participate in registries that collect evidence showing how they work in the real world. The effect on people in clinical trials was minimal, less than 1 on a scale of 0 to 18. The drugs are ‘black boxed’ as there have been deaths in clinical trials from brain swelling and bleeds; they are very costly and involve multiple brain scans during treatment. Some leading experts, including Dr Rob Howard at University College London, have said they will not be prescribing it.
More importantly, why ignore the possibility that older people, especially those under stress, may be exhibiting signs of Mild Cognitive Impairment, not dementia?
Especially older people who have been taken to relatives’ homes for Christmas, and may be sleeping in a strange bedroom (especially one with lurid teenage posters on the walls!) and find themselves part of a chatty crowd expecting responses from them.
Mild Cognitive Impairment (MCI) is a treatable condition. It does not automatically lead to dementia. The Mayo Clinic says that 70 percent recover, It can be the result of anaemia (older people often can’t be bothered to cook for themselves), an underlying infection, depression and anxiety as well as stress, constipation, poor eyesight or hearing, vitamin or thyroid deficiencies, or the side effects of medication. (An article in national newspaper shows how having a positive attitude to ageing is important.)
The difference between MCI and early dementia was highlighted in a conversation between me and a concerned daughter recently. Her mother struggles with depression and had shown MCI until recently, when the symptoms became more marked. Leaving after a visit Pam assured her mum that she would telephone as soon as she reached home and confirm she’d arrived safely. But when she telephoned, her mother had completely forgotten her visit. That indicates more than MCI. Now she and her brothers are looking at ways they can support her – and they are grateful for her church, which is ‘marvellous’, says Pam. But as well as my research, an ongoing experience with a friend close to me shows that social carers are scarcer than hen’s teeth.
The press story would be more helpful if it showed ways of recruiting more domiciliary carers, as family caregivers struggle to cope. ‘There are days when I wake up and feel that I can’t do this for one more single day,’ said a wife.
As it is, I wonder if the aim of the release is simply preparing the way to put pressure on the Government and bodies such as the National Institute of Clinical Excellent to approve the new drugs.
