Would doctors routinely asking older patients about their memory improve dementia outcomes? No.

We are already screening for dementia. Never mind the evidence based conclusion from the UK National Screening Committee that “screening should not be offered,” our hospitals now receive financial incentives to do exactly that. In early 2012 the Department of Health’s new Commissioning for Quality and Innovation (CQUIN) payments aimed to increase the rate of diagnosis of Alzheimer’s disease by asking everybody admitted to hospital over the age of 75 whether they have been more forgetful in the past 12 months to the extent that it has significantly affected their daily life. The question has to be asked within 72 hours of admission, and hospitals must achieve 90% compliance over three consecutivemonths before payment. Patients answering “yes” must have a “diagnostic assessment.” The CQUIN document says that this is “awareness raising rather than formal screening.” But what is screening if it is not looking for a condition that the patient did not complain of or demonstrate symptoms of? And importantly, evidence of benefit is lacking. We do not have clear data on the positive predictive value of the question in real life or knowledge of the amount of harm that will be caused through overinvestigation and the lack of consent for the process. The same document claims that anxiety will be raised unnecessarily, “only if the process is done badly,” and justifies it by claiming that “doing nothing is not an option.” Nevertheless, it admits that, “There will never be enough old age psychiatry liaison teams to assess, diagnose, and manage people with dementia in the general hospital,” and that, “Help from organisations such as the Alzheimer’s Society will be important.” So there is resource to pay for non-evidence based screening, yet a seeming acceptance that the NHS cannot offer adequate specialist care, and that people will be directed to the third sector instead. This is a disservice to people with life impairing dementia, but it is also disease mongering in people with mild or occasional memory problems who live well. Patients in the community are also to be screened—the Department of Health has said that the general practitioner contract will “reward practices” that screen patients at supposedly high risk of dementia. We know the harms of screening have been insufficiently studied. We know that it will often detect mild cognitive impairment and that this does not necessarily progress to dementia. Industry influence