Just forget it

In the last month I’ve managed to lose my keys and my purse, have turned up on the wrong day for a meeting and clean forgot about a long-arranged night out. Blips such as these often bring people into my consulting room with the question: am I going mad? There are many who fear a diagnosis of dementia even more than they fear cancer or heart disease. It’s easy to see why, given the loss of independence and personality that can accompany the disease.

I can write off my fears because my work is usually organised and my to-do lists get done. But the question of when memory starts to be pathologically faulty is a vexed one. If one’s life is perhaps over-full, or there is background stress, anxiety or depression, memory can become unreliable. When that underlying problem is treated, memory should be restored.

So how likely is it that memory problems are the first sign of a dementing illness? The truth is that most people with memory problems do not have dementia. There is research to prove it. For example, in a study published in the British Medical Journal a group of people in Sweden were asked if they had memory problems and were also given two memory tests. If someone said they had problems and it was then confirmed by the tests, this did predict dementia – but only 18 per cent of future cases of dementia were predicted by these tests. You were no more likely to go on to suffer dementia if you complained of memory problems than if you did not.

Other research offers uncertainty. Some studies are keen to point out that dementing illnesses often start with subtle problems of memory – but it would be surprising were it found to be otherwise. Elsewhere, it has been indicated that memory problems in highly educated people may be more likely to suggest an underlying pathological cause such as dementia. Does this mean that if you are more educated and have problems, you should think of dementia as a possible cause and seek advice sooner? The jury is out.

Meanwhile, research teams around the world are trying to find a quick and accurate test to diagnose dementia as early as possible. Recently there have been jubilant stories in the media about a “simple blood test” for a protein, clusterin, which can diagnose Alzheimer’s disease “10 years earlier”. The problems here are legion: false positives, false negatives and a lack of effective treatments to administer at this early stage.

The one good argument for early diagnosis – that it gives time for proper planning and for the patient to organise their affairs – doesn’t apply only to people with a progressively dementing illness. Making a will is something everyone needs to remember.

Margaret McCartney is a GP in Glasgow

margaret.mccartney@ft.com

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