Dissociation screens and dementia diagnosis
Research type
Research Study
Full title
Do dissociative screens have predictive and discriminate validity for differential diagnoses of dementia and functional memory disorder?
IRAS ID
273569
Contact name
Chloe Herrick-Bourke
Contact email
Sponsor organisation
University of Birmingham
Duration of Study in the UK
3 years, 5 months, 29 days
Research summary
Research Summary
This research aims to explore whether certain mental health factors may differ in their severity between people with a dementia (a progressive disease) and a functional memory problem (a memory problem which is not progressive in nature). The two categories of memory complaints can be difficult to differentiate, and currently we rely on neuroimaging and neuropsychological testing. However, under the pressure for a timely diagnosis, and with the limited number of psychologists working in memory services, there is a danger of misdiagnosis. FMD are usually related to combination of factors that impact on concentration and attentional ability. Documented in literature are also clinical features that appear to differ between FMD and neurological conditions based on clinical experience from memory services (Stone et al, 2015). These clinical features include age and whether or not the client attends their appointment alone (Stone et al, 2015).The study aims to recruit around 50 patients from the NHS memory services to help explore whether measures of symptoms such as dissociation, anxiety and depression might differ between the two groups and thus be helpful in creating a tool to help differentiate between the two diagnoses.
Summary of Results
It is estimated that there are 900,000 people in the UK living with dementia (Alzheimer Research UK, 2019). Dementia is characterized by acquired losses of cognitive ability and emotional ability which interfere with quality of life and daily functioning (Geldmacher & Whitehouse, 1996). The Prime Minister’s 2020 Challenge on Dementia aims for dementia services to be diagnosing dementia within six weeks from a general practitioner (GP) referral (Department of Health and Social Care, 2015). In March 2020, an audit was published which explored the performance of memory services in five regions of NHS England (Dementia Clinical Network, 2020). Overall, only 26% of patients were diagnosed within the six weeks of referral, with an average waiting time of 5 weeks for a brain scan alone (Dementia Clinical Network, 2020). The audit concludes that memory services need to consider how they can streamline services in order to work towards timely diagnosis.There are many barriers to a timely diagnosis. One of those barriers is ensuring accurate diagnosis between Functional Memory Disorder (FMD), Mild Cognitive Impairment (MCI) and Dementia which can present similarly in memory assessments and therefore often result in further examinations such as brain scans and referrals to neuropsychology. The diagnoses are distinctively different, and each require a different treatment pathway. Dementia is a progressive illness whereas MCI and FMD are not. FMD are usually related to combination of factors that impact on concentration and attentional ability, including mental health difficulties and pain. MCI on the other hand, is characterised by objective cognitive impairment but not to the extent of dementia and without progression or impact on daily living skills (NHS, 2014). If one can find more reliable and efficient ways to differentiate between diagnoses, then this could help reduce waiting times.
Researchers at the University of Birmingham sought to investigate the predictive validity of psychometrics and an effort and engagement measure in differentiating between Dementia, FMD and MCI. A hierarchal linear regression was conducted to explore predictive factors of diagnosis (also including person characteristics, neurological factors and cognitive factors as collected as part of a standard memory assessment). Researchers found that predictive factors of age, attending alone, a commonly used screening measure (ACE-III) and depression all hold discriminant value between diagnoses. In particular, patients with FMD are younger than Dementia and MCI patients, have higher ACE-III scores than those with Dementia and are more likely to attend to alone than the other diagnoses.
Researchers found preliminary evidence to support a phenotype of FMD which could be used to help create a screening measure in order to diagnose more effectively in terms of time and accuracy.
For more information, please contact Chloe Herrick-Bourke, School of Psychology, University of Birmingham, CEH444@student.bham.ac.uk
Note to editors: The University of Birmingham is ranked amongst the world’s top 100 institutions.
REC name
South West - Cornwall & Plymouth Research Ethics Committee
REC reference
20/SW/0070
Date of REC Opinion
4 May 2020
REC opinion
Favourable Opinion