Early diagnosis is key to care of dementia

GPs should diagnose dementia as early as possible rather than use watchful waiting, according to a GP expert in dementia.

GPs were taking too long to refer patients with dementia to secondary care, Newcastle GP Dr Louise Robinson, who has researched dementia and ageing at Newcastle University, told the annual Primary Care Neurology Society Conference in Birmingham last week.

'GPs are the first point of medical contact for dementia patients but they take, on average, 18-30 months to make a diagnosis of dementia,' she said.

'The delay in diagnosing dementia can, in some cases, take up to four years.'

Research has shown that 40 per cent of GPs are reluctant to diagnose dementia early, with the majority not using the mini mental state examination (MMSE), said Dr Robinson.

'This may be down to a variation in skills among GPs, a lack of specialist mental health services or a tendency for preferring watchful waiting,' she said.

'It is not for GPs to decide when to tell patients they have dementia.

Patients want to know as soon as possible so that they can have a say in the matter.'

She said early diagnosis allowed patients and families to adjust both emotionally and practically to the illness. Patients would be more aware and able to influence their care.

After the conference, Glasgow GP Dr Ken O'Neil, who has an interest in dementia, agreed that it was important to diagnose early.

'But it will have a minimal affect on the actual progression of the disease,' he said.

Screening tools, such as the MMSE, are not fully utilised in primary care, where many GPs are unfamiliar with their use, added Dr O'Neil.

Dr Stephen Iliffe, north London GP and member of the NICE dementia guideline development group, said that dementia was a serious label and that applying it wrongly could prove very hazardous.

'GPs are cautious when making a diagnosis because of the actual difficulty in distinguishing early cognitive impairment from normal ageing and depression.'

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