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Public support for the implementation of personalised medicine policies (PMPs) within routine care is important owing to the high financial costs involved and the potential for redirection of resources from other services.
We aimed to determine the attributes of a PMP most likely to elicit public support for implementation. We also aimed to determine whether such support differed between a depression PMP and one for cystic fibrosis.
In a discrete-choice experiment, paired vignettes illustrating both the current model of care (CMoC) and a hypothetical PMP for either depression or cystic fibrosis were presented to a representative sample of the UK public (n = 2804). Each vignette integrated varying attributes, including anticipated therapeutic benefit over CMoC, and the annual cost to the taxpayer. Respondents were invited to express their preference for either the PMP or CMoC within each pair.
The financial cost was the most important attribute influencing public support for PMPs. Respondents favoured PMP implementation where it benefited a higher proportion of patients or was anticipated to be more effective than CMoC. A reduction in services for non-eligible patients reduced the likelihood of support for PMPs. Respondents were more willing to fund PMPs for cystic fibrosis than for depression.
Cost is a significant factor in the public's support for PMPs, but essential caveats, such as protection for services available to PMP-ineligible patients, may also apply. Further research should explore the factors contributing to condition-specific nuances in public support for PMPs.
This study aimed to review the evidence base regarding cognitive impairment and the development of dementia in patients with very late-onset schizophrenia-like psychosis (VLOSLP).
We conducted a systematic literature search of PubMed, PsycINFO and Web of Science according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Two reviewers independently screened records first by title and abstract and then by full text, resolving differences after each stage. Selected studies were assessed for quality using the GRADE system, and data on study design, participants, cognitive ability and rates of developing dementia were extracted and synthesised.
Seventeen publications were identified for review. They were generally poor in quality and heterogenous in design. VLOSLP patients were found to have impaired global cognition compared to non-psychotic controls, but no difference was found between VLOSLP patients and aged early-onset schizophrenia (EOS) patients. No single cognitive domain was consistently affected. Patients with VLOSLP demonstrated significantly higher rates of dementia diagnosis (ranging from 4.4% over 3 years to 44.4% over 15 years) than controls, but no difference was found between VLOSLP patients and aged EOS patients.
VLOSLP may not necessarily predict cognitive decline, but few studies have adequately investigated cohorts on a longitudinal basis. Heterogeneity between and within cohorts and varying selection criteria compromise the clinical generalisability of studies investigating the association between VLOSLP and neurodegenerative disease. Further studies on the clinical presentation, cognitive profile and neuropathology of VLOSLP with comparison to EOS/late-onset schizophrenia (LOS) and neurodegenerative disease are needed to better inform the diagnosis and management of VLOSLP.
Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.
This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.
We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.
The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.
Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.