Timely diagnosis
When is diagnosis timely?
We consider diagnosis to be timely when it is established at a point on the trajectory of dementia progression when people with dementia and their family and friends first notice changes in cognitive function, daily activities, behaviour and/or interpersonal relationships and become worried enough to seek help and come to the attention of health and social professionals. This is the time when they can use the information provided by the diagnosis to understand what is happening, make lifestyle changes, and plan for the future.
Currently, the diagnosis is delayed in many cases or established only at the moderate or late stage of dementia. Major reasons include low public awareness of the early signs of dementia, denial of problems in people with dementia and other defence mechanisms, concerns of physicians regarding diagnostic uncertainty, poor treatment options, emotional distress of Alzheimer’s and other dementias on family members, and misperceptions about Alzheimer’s and other dementias.
Changing the current practice and making a timely diagnosis possible requires increasing public and professional awareness of the initial symptoms of dementia as well as improving knowledge among healthcare professionals about the benefits of a timely diagnosis and early intervention.
A diagnosis will happen timely if people notice changes in abilities and behaviors and quickly act upon it.
What are the benefits of timely diagnosis?
Timely diagnosis has benefits for people with dementia, caregivers, professionals and healthcare providers. Earlier and more accurate diagnosis avoids “medical nomadism” which begins with help seeking and ends with receiving a definitive diagnosis and treatment. It may reduce feelings of uncertainty and anxiety in people with memory complaints and their families. Prompt evaluation also facilitates the detection and treatment of alternative or concomitant causes for memory problems and behaviour change (e.g., depression, anxiety, sleep disorders) as well as the identification of conditions that require immediate action (e.g. delirium, intoxication). Furthermore it may prevent the prescription of medications that worsen cognitive function.
A timely diagnosis provides benefits to people with dementia, their carers and professionals.
References
- Blendon RJ, Benson JM, Wikler EM, et al. The impact of experience with a family member with Alzheimer’s Ddsease on views about the disease across five countries. Int J Alzheimers Dis 2012: 1–9, 2012.
- Brooker D, Fontaine JL, Evans S, et al. Public health guidance to facilitate timely diagnosis of dementia: ALzheimer’s COoperative Valuation in Europe (ALCOVE) recommendations: Timely diagnosis of dementia. Int J Geriatr Psychiatry 29: 682–93, 2014
- Carpenter BD, Xiong C, Porensky EK, et al. Reaction to a dementia diagnosis in individuals with Alzheimer’s disease and mild cognitive impairment. J Am Geriatr Soc 56: 405–412, 2008.
- Dubois B, Padovani A, Scheltens P, et al. Timely diagnosis for Alzheimer’s disease: A literature review on benefits and challenges. J Alzheimers Dis. 49: 617–631, 2015
- Iliffe S, Robinson L, Brayne C et al. Primary care and dementia: 1. Diagnosis, screening and disclosure. Int J Geriatr Psychiatry 24: 895–901, 2009.
- Prince M, Bryce R, Ferri C. World Alzheimer Report 2011: The benefits of early diagnosis and intervention. Alzheimer Disease International 2011 [http://www.alz.co.uk/research/WorldAlzheimerReport2011.pdf
- Samsi K, Abley C, Campbell S et al. Negotiating a labyrinth: experiences of assessment and diagnostic journey in cognitive impairment and dementia. Int J Geriatr Psychiatry 29 :58–67, 2014