Islington: National champion in diagnosing dementia

Islington borough has a high rate in diagnosed dementia compared to the average in the UK. How is Islington achieving such a high rate and what can be done to improve early diagnoses?

According to the Department of Health, only 45% of the population living with the illness is diagnosed in the UK, with an estimated 351,000 people thought to be undiagnosed.

Symptoms of dementia, such as memory loss or problems with language, can mean that the condition can go undetected for some time. Diagnosing dementia early enables the patient to have access to treatment, information and care.

The borough of Islington has an especially high rate of dementia diagnosis, about 64%.  This represents 0.39% of adults in the borough according to the Public Health Observatory.

In 2011, 787 people were recorded as living with dementia in Islington, according to  NHS England. The NHS is expected to invest £90 million next year in hopes to diagnose the estimated two-thirds of people living with dementia who are still undiagnosed.

To get a diagnosis, people who might have noticed signs of dementia have to visit their GP who will look at their medical history and talk with them to see if the symptoms are not caused by another condition. The person can then be referred to a Memory Service, which includes clinical psychologists and specialised consultants and nurses, who will visit the person  and assess their thinking and memory. They will ascertain if the person lives with the condition and which type of it.

Peter Todd, Operation Manager at the Alzheimer’s Society of North-West London gives several reasons explaining the success of diagnosing dementia in Islington. Alzheimer’s Society has worked closely with the borough to raise awareness about dementia and it has a “good mix of support services available in the borough,” says Todd. Islington counts five voluntary organizations for care and support, several community based home services and four care homes.

What’s hindering diagnosis

The main difficulty of diagnosing dementia lies in denials – both on the side of the person living with it and sometimes the person caring. Micheline Lobjois, a Camden resident whose aunt and mother both lived with the condition, says that both her relatives refused help. “They never acknowledged that there was anything wrong. That was very difficult for us because we didn’t know what to do,” says Lobjois.

The diagnosis can also be compounded by various factors like lack of knowledge about the condition and different understandings, as well as inequalities of access to information and care. Todd says that knowledge about dementia should be more spread to ethnic groups as  “we live in a multicultural society and there are communication barriers”. Alzheimer’s Society is currently running a programme to connect communities and developing an information plan for South Asian families.

Doctors’ lack of specialist knowledge to identify the condition can also hinder the early diagnosis of dementia, according to Peter Todd. Symptoms such as short-term memory loss are often mistakenly allocated as depression or stress.  Todd describes how it took time for his mother-in-law to be diagnosed:  “Yvonne was 74 when she started losing her short-term memory. She was not diagnosed until four years later. The reason for the delay was that she was in denial for a couple of years and then following a visit to the GP it took a further two years to get an official diagnosis.”

Early diagnosis as a priority

Last February, Health Secretary Jeremy Hunt pledged faster diagnosis times for people suspected to live with dementia. He wants people to get a diagnosis within six weeks, instead of the current average of six months. Diagnosing dementia early is now a national priority.

Gill Livingston, a professor of psychiatry at University College London and a dementia researcher, says that it makes a huge difference if somebody knows early that they have dementia. “They are able to make decisions about their future such as how they would like to live, the sort of care they would want,” he says. “They can decide about their will and the power of attorney so that people they really trust can look after their finances and living situations, should they not be able to make decisions themselves.”

Early recognition that a person lives with dementia enables family members to understand that their relative is not just becoming difficult or doing things a different way on purpose. Until now research has not led to a cure. Livingston insists on the importance of research in early diagnoses and on the need to diagnose more people living with the illness. “By the time people are quite far on with dementia and have moderately severe or moderate dementia, a cure would not work as the brain would be too damaged,” she says. “To have a cure and access to information and appropriate care goes hand in hand with having an early diagnosis.”