Case study: increasing dementia diagnosis rates in Wales

This case study highlights how a national and collaborative approach to offering FDG-PET scanning aims to increase the effective and timely diagnosis of dementia.

This approach follows a successful pilot project from Aneurin Bevan University Health Board's (ABUHB) Older Adult Mental Health, and Radiology Directorate; with support from Wales Research and Diagnostic Positron Emission Tomography Imaging Centre (PETIC) and the Royal College of Psychiatrists Wales.

A unique, national approach is now in place with the support of the Welsh Health Specialised Services Committee (WHSSC) and the Welsh Government. This case study highlights the background to FDG-PET, the methodology and outcomes of the pilot study in ABUHB, as well as the next steps for the national project.

  • Alzheimer’s Disease (AD) affected 46,800 people in Wales in 2019, with numbers projected to increase to 55,700 by 2025 and 79,700 by 20401.
  • 1 in 14 people above 65 years are affected by AD and two-thirds are women who are the major care givers2.
  • Key aspirations for the Dementia Action Plan Wales (PDF) are to increase number of people formally diagnosed with dementia by 3% annually and to improve early diagnosis and timely interventions.

References

  1. Wittenberg R et al (2019) Projection of older people with dementia and costs of dementia care in the UK 2019 -2040, Care Policy and Evaluation Centre, the London School of Economics and Political Science
  2. Prince, M et al (2014) Dementia UK: Update Second Edition report produced by King’s College London and the London School of Economics for the Alzheimer’s Society

The background of FDG-PET

FDG-PET is a highly useful imaging modality for the diagnosis of uncertain or difficult to diagnose primary neurodegenerative disorders.

Patterns of altered cerebral glucose metabolism seen at FDG-PET are useful as imaging biomarkers to assist in making the clinical diagnosis of neurodegenerative diseases causing dementia.

Implementing FDG-PET into a health board service

A pilot project was established by ABUHB in late 2019. The project aimed to benefit patients in the Gwent area; increasing earlier diagnosis and diagnostic rates for dementia, achieving more reliable diagnosis of dementia subtype, enabling earlier disease-specific treatment and access to psychosocial support and reduction of carer burden.

The project was also developed with a view to scaling to a national offer should it generate positive outcomes.

A national approach to FDG-PET in Wales

Following the pilot project the Welsh Health Specialised Services Committee has commissioned FDG-PET scans for dementia nationally.

ABUHB have committed to a number of actions in continuing work into developing and enhancing the infrastructure for early and effective diagnosis of dementia. This includes:

  • continuing to provide access to access to Amyloid PET scans in ABUHB for patients with suspected dementia where the diagnosis is uncertain
  • piloting a CSF analysis pathway to aid diagnosis of dementia in ABUHB.

Next steps

  • Health Boards have identified clinical leads who will hold responsibility within their MDT for referral for FDG-PET.
  • In partnership with PETIC, The Royal College of Psychiatrists Wales has held a workshop with clinical leads across Wales to highlight the project and clinical pathway.
  • A regular schedule of meetings is being established with clinical leads across Wales to discuss progress in embedding FDG-PET, this is in partnership with colleagues in radiology.
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