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Political Drive To Screen For Pre-Dementia: Not Evidence Based And Ignores The Harms Of Diagnosis, David Le Couteur, Jenny A. Doust, Helen Creasey, Carol Brayne
Political Drive To Screen For Pre-Dementia: Not Evidence Based And Ignores The Harms Of Diagnosis, David Le Couteur, Jenny A. Doust, Helen Creasey, Carol Brayne
Jenny Doust
Current policy in many countries is aimed at increasing the rates of diagnosis of dementia and cognitive impairment.1 2 3 This policy drive has been accompanied by research into early detection of dementia, including preclinical identification of underlying neurobiology that might later be associated with dementia.4 Although the clinical features of people with established dementia are unmistakable,5 6 the ability of these preclinical features to predict future disease is less clear. Nevertheless, the belief that there is value in screening for “pre-dementia” or mild cognitive impairment is creeping into clinical practice, with the resulting overdiagnosis having potential adverse consequences for …
Diagnosis In General Practice: Using Probabilistic Reasoning, Jenny Doust
Diagnosis In General Practice: Using Probabilistic Reasoning, Jenny Doust
Jenny Doust
Diagnostic tests—whether clinical signs, imaging, or laboratory tests—are imperfect: there is always a possibility that test results are inaccurate and our diagnosis is wrong. However, we need to make decisions about whether to treat or not to treat patients, and so we need to feel confident that our diagnosis is above a certain threshold before we decide to treat a patient and below a certain threshold if we decide to withhold treatment. The threshold depends on the disease and the potential harms and benefits of treating or not treating patients. Unless we have clear strategies to cope with the uncertainties …