Screening for Dementia - Hype or Hope?
Dementia Awareness Week 2014 takes place in the UK this week with the aim of encouraging those with personal concerns to talk about them. Dementia is an important public policy concern and currently has a high profile in this arena and in the news. This is because of the growth in the number of elderly people and the increasing prevalence of dementia in aging populations.
In the UK these developments have prompted calls for the introduction of screening. Some primary care groups are already using financial incentives to drive up detection rates to meet new government dementia diagnosis targets - targets that have drawn significant criticism for their potential to cause substantial harm.
The diagnostic instruments available to health professionals in routine practice are very blunt tools. "Bedside" paper-based cognitive testing might be sensitive but is also non-specific and rendering high numbers of false positive results, which raise concern in patients and extra costs from subsequent clinical work up.
Despite frequent, often overblown, press reports of breakthroughs, the quest to develop a quick, acceptable, cheap and reliable dementia biomarker continues. Biomarkers usually identify only Alzheimer’s disease (the most common, but not the only cause of dementia) and are often reported in populations with high prevalence of this disease. A full evaluation of biomarkers as a screening, or predictive, tool in the general population is still to emerge.
Early diagnosis of dementia can be valuable, potentially opening the door to effective interventions. The medical options to treat dementia, however, are limited. Medication for Alzheimer’s, for example, ameliorates symptoms but does nothing to alter the underlying disease process. Using treatment in a wider framework - having an understanding of the distressing changes that dementing illnesses cause and a sense of what the future may bring the patient - can be of great value.
Diagnosis opens access to support for patients and those that care for them. Support can help with practical issues (e.g., how to manage personal finances) and ease the emotional burden that living with dementia entails. But this approach is not for everyone. Many people do not wish to be made aware of a diagnosis of this nature until they have significant impairment of their health and wellbeing.
Whilst this might appear a gloomy picture, the advocacy of the UK government during its presidency of the 2014 G8 Dementia Summit has provided significant impetus to develop international co-operation in dementia research. The UK funding for research will increase to £66 million by 2015 while the U.S. has committed to spending $550 million.
Today, screening for dementia in the general population cannot be justified with the instruments and treatments available but this is likely to change in the near future, given renewed impetus to the research agenda.
What would the impact of a breakthrough be on the insurance industry?
- Significant advances in dementia diagnosis and treatment could impact annuity writers if improved treatments increase life expectancy materially.
- Other life insurers are unlikely to see a notable change in experience because term assurance makes up the bulk of their portfolios and these benefits typically cease by age 70. (Screening is unlikely to be recommended before people reach their 60s, given low dementia prevalence at younger ages).
- Critical Illness claims require not only a definite diagnosis but also levels of impairment for Alzheimer’s disease and other forms of dementia. Screening among people who do not have these levels of impairment should not increase claim rates.