Dementia Screening and Early Diagnosis: the case for and against

Over 700,000 people have dementia in the UK. There is increasing policy and practice consensus that early intervention in identifying and treating dementia is beneficial and that much can be done therapeutically and practically to help users and their relatives at an early stage. Research evidences early diagnosis as allowing users the chance to come to terms with it when they can still understand its implications. It also provides an opportunity for key decisions to be made and is what the majority of people want. However, early diagnosis also carries risks: loss of status, acquisition of a stigmatising label, loss of employment and, for a minority, depression. Not all users want to know they have dementia; the diagnosis may also be incorrect. Evidence from the field of medical sociology offers a different perspective on the early intervention debate suggesting not only that targeting ‘well’ older people at possible risk of dementia may be the latest product of surveillance medicine but that efforts to resist being diagnosed may represent strategies to challenge medical intrusion, knowledge and power. Further, the imposition by an older person and their family of their individualised values onto the clinical encounter may be viewed as an attempt to import user generated forms of knowledge into a medically managed process and provide a nuanced approach to defining, and dealing with, risks. Accommodating both perspectives in practice development may hold considerable potential to enhance the nature of care and the quality of lives of people with dementia and their families.