“Undiagnosing” dementia – Letter in BMJ, Dr Peter J Gordon

bmjimage“Undiagnosing” dementia in the BMJ

Peter J Gordon, locum NHS psychiatrist for older adults

in Letters:Target diagnosis rates in primary care.  Published 20 January 2015

BMJ 2015;350:h290

“Brunet raises the difficult subject of “undiagnosis.”1

Scotland, long before England, had a financially incentivised target for “early diagnosis” of dementia. This was HEAT target 4, which was set for all 12 NHS boards deployed at secondary rather than primary care level.2

The Scottish government, having reached this target, has not shied away from stating that it did “quite well” in reaching the target.3

As a specialist doctor in dementia I am now facing the return of elderly people who were diagnosed with “early Alzheimer’s disease,” but who many years on show no signs of dementia (they do not fulfil clinical diagnostic criteria for dementia and have shown no signs of progression).

These people thought that they had dementia or “Alzheimer’s.” Some have lived with this for seven years or more. They have generally had post-diagnostic counselling, and families and friends have also adapted to the diagnosis. Driving, autonomy, and insurance may all have been affected.

In many cases this was the direct result of an approach based on “early diagnosis” set as an incentivised target.

If we must have a target based approach (which I very much doubt), ethics must be considered from the outset.”


Cite this as: BMJ 2015;350:h290


  • Competing interests: None declared.


  1. Brunet M. Target diagnosis rates in primary care are misleading and unethical. BMJ2014;349:g7235. (2 December.)
  2. Scottish Government. HEAT standard. www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance/DementiaStandard.
  3. All-Party Parliamentary Group on Dementia. Inquiry. How to improve dementia diagnosis rates in the UK. Minutes of the oral evidence session 13 March 2012:26. www.alzheimers.org.uk/site/scripts/download.php?fileID=1396.



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