Home | Blogs | World Alzheimer Report 2021: Journey through the diagnosis of dementia

World Alzheimer Report 2021: Journey through the diagnosis of dementia

idea.nottingham.ac.uk image: Dementia Day to Day blogs banner

dementia awareness, education and training, research

Alzheimer’s Disease International has been producing annual reports for over a decade and they provide a most valuable resource, with up to date worldwide figures on dementia and providing a welcome global perspective. Each report is themed, for example looking at the numbers of people with dementia or at the costs attributable to dementia. In 2021, ADI has gone back to the topic of diagnosis, which was last covered in 2010.

The report is something of a mammoth document at over 300 pages long, so not everyone is going to read every word. The executive summary is three and a half pages, so that’s more manageable, or there is an online slide presentation at https://www.alzint.org/u/WAR-Launch-Slides-2021-4.10.pdf, as well as which ADI is hosting a short series of webinars about the report.

The main authors of the report are a team from McGill University in Canada, led by Professor Serge Gauthier, who were commissioned by ADI. Data from the report are provided by (1) the results of a survey of clinicians (>1000), carers (>2000) and people with dementia (<200) who were asked about their attitudes towards and experiences of diagnosis; (2) a series of essays on diagnosis-related topics by invited experts; plus (3) ten personal testimonies written by people with dementia or relatives. Altogether there are about 75 contributions from around 200 authors, and these are organised in six sections, with a total of 25 chapters.

The foreword is by Paola Barbarino, CEO of ADI, who quotes various figures and describes the growing challenges of dementia as a perfect storm. She discusses the importance of diagnosis, especially that it should be more widely available, prompter, and established earlier. She concludes that, for various reasons, the world is still in denial about dementia.

The six sections that comprise the main report are: clinical assessment; laboratory tests; personal testimonies; formulation of diagnosis; particular circumstances; and the future of diagnosis. These mirror the patient’s journey through the diagnostic process. A strong message is that diagnostic tests for various types of dementia are becoming better established, and tests such as blood biomarkers for Alzheimer’s disease are likely to become routine. A consequence of this is that it can become possible to diagnose the pathological process of Alzheimer’s disease ahead of waiting for clinical symptoms of dementia to develop. In turn, this opens the prospect of earlier treatments; however, we need to be sure that diagnosis so early is accurate and that potential treatments actually work before we decide that we really can prevent dementia.

Different readers will be attracted to different chapters. For example, personal testimonies are always moving, and it is good to see them here. I confess I haven’t read every chapter but I did look out the one about re-evaluation of diagnosis over time. This is a tricky issue for clinicians. The commonest problem that my colleagues and I encounter is where someone has been diagnosed as having dementia but, over the course of time, the condition has not progressed as might have been expected, or even may have improved. I know someone who has been on a cholinesterase inhibitor for over 20 years, so I don’t think they have Alzheimer’s disease. Someone else I know was re-diagnosed as having mild cognitive impairment (MCI) rather than dementia and felt embarrassed at having spoken at events as a person with a diagnosis. However, the ADI report doesn’t touch on this problem, unfortunately, and instead the authors are more concerned with shifts in labels between different types of less common neurological dementias, such as progressive supranuclear palsy and corticobasal degeneration.

Overall, though, it is an impressive state-of-the art read. The essays are brief and well-referenced, so there’s a good source of material. I realise that it must have been a herculean feat of editing to get all the contributions on board and published for World Alzheimer’s Day, 21st September.

Your comments

You'd be very welcome to leave a comment on this blog post. 

Your comment won't appear straight away as we'll need to check it first: thank you for your patience.

When leaving comments please bear in mind our posting rules.

Add new comment

This is for testing whether or not you are a human visitor and to prevent automated spam submissions.

See more like this

Alice Worrall

Most people know the devastating impact that dementia can have on a person and their family, and it is rare to find someone who has not known someone affected by the disease in the UK.

Tom Dening

Hearing loss is common as we get older. Age is the main risk factor for dementia. The two conditions may occur together, but can deafness cause dementia?

Karen Harrison Dening

I recently attended an international research workshop that aimed to elicit the views of attending ‘experts’ in the field of dementia research and care.  The focus of the workshop was to explore methodology that examined the receptivity of ‘early diagnosis of Alzheimer’s disease’ across various s