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| Brain scan in Dementia |
There are no treatments that offer anything but a mild alleviation of the progression in a few cases. That fact is important and should be considered, but essentially it is a progressive and slow progress.
Politicians are saying that early diagnosis is important, and we are not very good at it.
I beg to differ. Early diagnosis just makes people more aware of the future that they have, and has not benefitted any of my patients (as far as I can tell) who had prompt diagnosis. I have also had patients diagnosed in error as well. Early diagnosis matters not a great deal at all.
The use of anti-psychotic treatments in dementia is also controversial. Few of my patients are on these drugs, but the occasional one is, and they are pretty stable. I am not minded to change the treatment on the fiat of any Government or Quango.
It looks like the current Government has caught the interfering-unnecessarily-to-placate-interest-groups bug from their predecessors.
Policy by soundbite all over again.
4 comments:
The trouble with all these government policy statements is, unfortunately, to make people suspicious of the advice being offered by their GPs.
Is the advice being offered because the GP genuinely believes that it is the best for me, or is it being offered because the government says it is the thing to do? Even worse, is it being offered because the Government has some target for practices, and they are trying to meet it in order to get a bonus?
Fortunately, I've had my present GP for about 30 years and I feel that I can trust him (he also knows that I'm very capable of telling him what I think if I have any doubts!). I've already told him that I don't want the flu jab this year, particularly as the government seems to want to get rid of its surplus swine flu vaccine by mixing it with this year's variant!
Jobbing Doctor,
Thanks for giving dementia an airing.
With both of my parents currently in a nursing home and each steadily deteriorating with varying symptoms of dementia, I can confirm that it's an awful condition.
It's proving to be a very long goodbye.
Regards,
Steph
I'm persuaded that early diagnosis has benefits, for two main reasons.
Firstly, if it's a neurodegenerative dementia, acetylcholinesterase inhibitors can maintain cognitive function for a median duration of a bit over two years. It's better to be held for a couple years with an MMSE of 22 than of 12. Placement in care delayed by 18/12 also and maintained function/ADLs is desirable at the optimal (early) stage.
Secondly, it helps family (and the patient) organise stuff. LPA for health/social welfare, LPA for finace, will, DVLA/driving, dentistry (RCPsych advice is to go to the dentist before gum atrophy/dental problems/ill fitting dentures necessitate painfuil dentistry, lying down with sharp spiky bits thrust into your mouth when you're totally confused/reisstsing it all).
Seeing families coming to terms with diagnosis late, compared with early diagnosis, I think earlier diagnosis does benefit the patient and carers fractionally more.
Of course, as you say, dementia's a ghastly disease. If a patient's destined to die in x years, they will no matter what drugs are used (at present) so early diagnosis is purely for timely palliative care. And the rather than linear decline month on month, drugs afford stability for a couple years then a sharp crash over weeks when they stop working, with the same end point being reached at the same time. That's a grim consequence of early diagnosis and treatment (MMSE maintained at 22/30 say for 2.2 years, then over weeks crashes down to below 10/30 and drugs aren't working/are withdrawn).
Oh, I've thought of another reason. Early diagnosis means you can request social services and OT input, which in my corner can have almost a 2 year wait for non-urgent stuff. Referral in early dementia means when the patient needs practical input, they're near the top of the list ;-)
Sorry Shrink - I agree with JD on this. I have worn the T-shirt many times!
From your side of the desk - early diagnosis may appear advantageous - but what if you were the person living with this diagnosis. Okay, if you were bright enough or insightful - you may know your memory was fading and you might want an answer.
But whether you were bright enough or not - would you really want to konw? Would you want to wake every morning and think what have I forgotton now? Could you cope with this horror?
The right not to know has overtaken the right to know and patients suffer untold harm because of this.
I cannot believe that the majority of patients are undiagnosed with dementia - stupid GPs(!) - and as JD stated - famiies are most affected first!
We know!
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