Living with dementia magazine September 2010

Diagnosing dementia at an early stage gives people more time to access the right services and plan ahead, and also reduces care costs. A London-based research team is testing a new way of improving GPs' abilities to spot dementia and offer ongoing support by Caroline Bradley.

Good quality early diagnosis and intervention for all is a key goal of the National Dementia Strategy for England. Everyone agrees that primary care services have a vital role to play in making this happen. However, few of the suggested solutions have been tested in experimental studies.

Steve Iliffe is Professor of Primary Care for Older People at University College London, and Principal Investigator of a research project known as EVIDEM-ED*. His research team is looking at developing new ways of improving GPs' abilities to identify dementia at an early stage, and offer appropriate follow-up support.

Past research has shown that it is possible to improve the rate of diagnosis, but not the care and services offered afterwards. Professor Iliffe says,

'By tailoring this research intervention we hope to focus on the response as well as the diagnosis. This is not just about recognising dementia, it's about doing something about that recognition.'

On prescription

Researchers are working with 23 GP practices, all of which have more than 200 patients. Just over half the practices receive the team's intervention, with the others acting as controls. The team is half way through the three-year trial.

The first stages of the intervention involve a GP educator spending an hour with the practice staff to find out how they currently diagnose and handle cases of dementia.

Following the discussion, the educator produces an 'educational prescription' for the practice. This typically has between four and six items on it, all aimed at improving how the professionals interact with people affected by dementia. The items include ideas for improving practice, such as:

• considering new ways of assessing changes in people's behaviour
• ensuring the patient gets the most out of a medication review
• finding out about the availability of practical and emotional support for people with dementia in the local area

Practice staff are also offered a training programme designed to boost their skills and understanding.

The bigger picture

Dementia has proved difficult for GPs to identify as it is a complex condition that usually only becomes apparent through gradual changes in an individual's personality or behaviour.

Professor Iliffe says,

'We want to encourage the idea of a global assessment. Diagnosis is about recognising a pattern of change that adds up to dementia.  It's about considering how the person's behaviour has changed. We need to ask whether their memory has changed, of course, but there's too much emphasis on that, so we also want people to think about hobbies, personal care and daily activities.

'Are they struggling with things that they once found easy, for example? It's about stepping back and assessing the bigger picture.'

Better support

The EVIDEM-ED programme aims to move practices to a point of being able to offer a rounded package of support to people with dementia and their carers. Its aims are to improve diagnosis, but also to ensure that staff then make the necessary next steps. These may include ensuring that a medication review is meaningful to the person and their carer, managing any psychological or behavioural symptoms that arise, and attending to carers' needs.

As well as improving communication and empathy, a key element of the intervention involves raising awareness among the practice staff of voluntary sector services in the local area. This may involve finding out about Alzheimer's Society's services, or about the information the local authority can provide.

Professor Iliffe says,

'Practices don't have this information in a single place, so we collect it, laminate it and put it on the wall, or produce an electronic version for the desktop computer. Simply letting people know that services are available to them can have a significant impact on their ability to cope.'

Results?

The team will be ready to present its findings in about a year, and hopes that their interventions will have increased the number and quality of dementia reviews carried out by the practices. If this is the case, the NHS will have a proven method of making improvements available to them immediately.

*EVIDEM is the short title for a programme of research funded by the National Institute for Health Research. The programme includes five projects, of which EVIDEM-ED (early diagnosis) is one. All projects are investigating the impact of interventions for people with dementia. To find out more about the programme, visit www.evidem.org.uk/projects/evidem-ed