Disclosing the diagnosis of dementia

We read with interest the paper about truth-telling and the diagnosis of dementia (Pinner, 2000). The thrust of the article is that people with dementia should be told the diagnosis in the same way that patients are told that they are suffering from cancer. The disadvantages of this approach are stated but underplayed. In clinical practice it is common to see patients who have been told the diagnosis of cancer, sometimes with such frankness that they have gone on to develop major psychological sequelae and sometimes fatal decline.

We experienced this recently when a 58-year-old woman, after being made aware of her diagnosis of dementia, developed severe depression and suicidal ideas. The depression worsened her cognitive state and made her non-compliant to intervention. Cognitive decline makes patients more vulnerable and reduces their ability to cope with stress (Clafferty, 1999). Suicides after disclosure of diagnosis have been described (Rohde et al, 1995). Insight regarding progressive cognitive decline is an important determinant of reaction to disclosure. In insightful patients the risk of depressive reactions and suicide must be seriously considered after disclosure of any major illness (Maguire et al, 1996).

The debate about this issue is a further example of the importance of dealing with each patient as an individual. It is good practice for every patient to be informed about the illness and its implications. It is equally important to accept that some patients do not want to know the nature of their illness and informing them is harmful. This perspective needs greater emphasis in a climate when telling everyone is sometimes seen as the only approach.