1. The English experience of promoting dementia recognition and management in primary care Alzheimer’s New Zealand/ADI Conference November 3rd-5th 016
Steve Iliffe
Emeritus Professor of Primary Care & Older People
University College London

2. Dementia as a policy problem
Under- or delayed diagnosis
Therapeutic nihilism
Knowledge gaps
Numbers estimated by UK Alzheimer’s Society (2013): 856,700 people with dementia
Numbers estimated by CFAS 2 (2015): 670,000

3. Recognition and misattribution
Misattribution of early symptoms to events, experiences, personality or ageing delays help-seeking in almost a third of symptomatic people by up to two years
Feldman L, et al Carers' causal attributions of symptoms and help-seeking in dementia: a qualitative study Dementia 2015; Jun 30. pii:

4. From the Dementia strategy 2009 to the Prime Minister’s Challenge 2020
Incentivisation of diagnosis and management in general practice (Quality & Outcome Framework)
Proportion of expected case-load identified
Case-finding/Screening in general practice
Educational activities aimed at GPs
Memory services with diagnostic & support roles

5. Rewarding dementia management
Indicator
Points
Achievement thresholds
DEM001. A register of patients diagnosed with dementia 5
Not applicable
DEM004. % with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months 39
35–70%
DEM005. %with a new diagnosis of dementia with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels 6
45–80%
Actual achievement /maximum potential achievement x number of points available for indicator x £ value of a QOF point.  
Value of a QOF point = £ (2015/16) 
Full achievement: 50 points x £ = £8,006

6. Data sources THIN database ~ incidence of dementia
NHS data ~ prevalence of dementia
Freedom of Information Act data ~ selected memory clinic activity

7. THIN database analyses (1995)
476 group practices routinely using electronic medical records
1, 338,659 patients aged 60 or over
Rait G, Walters K, Bottomley C, Petersen I, Iliffe S, Nazareth I Survival of people with a clinical diagnosis of dementia in primary care BMJ 2010 Aug 5;341:c3584. doi: /bmj.c3584
Cooper C, Lodwick R, Walters K, Raine R, Manthorpe J, Iliffe S, Petersen I Observational cohort study: Deprivation and access to anti-dementia drugs in the UK Age & Ageing pii: afv154
Walters  K., Hardoon  S., Petersen  I., Iliffe  S, Omar  R., Nazareth  I., Rait  G. Predicting dementia risk in primary care: development and validation of the Dementia Risk Score using routinely collected data BMC Medicine 2016,14:6

8. Incidence of dementia in the THIN database
Dementia QOF begins

9. Trends in dementia code use 1995-2011

10. Prevalence of dementia (thousands) 2006-14
Alzheimer’s Society estimate (2013): 856,700
CFAS 2 estimate (2015): 670,000

11. Prevalence of dementia (%) 2006-14
Alzheimer’s Society estimates prevalence at 1.3% (2013)

12. Referrals to 11 memory clinics, and proportions diagnosed as having dementia 2011-2015
Data obtained from a Pulse magazine Freedom of Information request, February 2016

13. Percentage of patients referred to memory clinics who receive a dementia diagnosis
Data obtained from a FoI request, February 2016

14. Time in days from referral receipt to first assessment, 12 memory clinics

15. Some comments and questions
After all these efforts, why is there no upturn in incidence or prevalence?
Is the upward trend in incidence or prevalence due to population ageing?
Coding in electronic medical records can skew data
Memory clinics are seeing more patients, faster, but fewer are being diagnosed with dementia.
Thank you for listening!