Local authority variations in the recognition of dementia are hardly surprising (Inequality leaving 115,000 dementia cases ‘undiagnosed’ in England, 23 October). Dementia is a set of symptoms that are influenced by exposures to different risk factors over the course of someone’s life. And while variations in access to scanners may exist, they play only a small part in the timely recognition of dementia. Scanners are expensive and need a new workforce to service them. Much more work would be needed to establish the “right” number of scanners and to recruit a new workforce for them.
Assumptions are often made about the value of early recognition, but the absence of effective and safe treatment for dementia means that screening of populations is ethically wrong. Timely recognition – when an explanation can be given for distressing memory loss, anxiety, depression or agitation – might bring relief to individuals and their families, but this does not justify diversion of resources to diagnosis campaigns. When there are calls for more memory clinics or more technology, we should always ask about the trade-offs being proposed. Prevention of dementia through public health approaches is one area where investment is sorely needed.
Steve Iliffe
Emeritus professor of primary care for older people, University College London
Jill Manthorpe
Emerita professor of social work, King’s College London
