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Ruling Questions Dementia Screening

MANAGED CARE December 2013. © MediMedia USA
News & Commentary

Ruling Questions Dementia Screening

A lot can change in 10 years, but not a ruling by the U.S. Preventive Services Task Force (USPSTF) about screening tests and possible treatments for early cognitive impairment. In 2003 the USPSTF said that there was insufficient evidence for or against. The task force has reaffirmed that position.

The screenings are meant to be performed by primary care physicians, and while they might detect dementia, “there is no empirical evidence that screening improves decision making” because there’s the question of whether interventions will do more harm than good.

“Expert consensus guidelines state that early detection of cognitive decline may be beneficial because clin­icians can optimize medical management, offer relief based on better understanding of symptoms, maximize decision-making autonomy and planning for the future, and offer ­appropriate access to services that will ultimately improve patient outcomes and reduce future costs,” the study states. “Although this is a logical argument, there is little or no empirical evidence to support it.”

The study “Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force” is in Annals of Internal Medicine. It includes a meta-analysis of approved anti-­dementia drugs that show only a slight benefit, say the authors.

“The average effects of changes in cognitive functioning observed in trials are small, and the clinical importance of population benefits is probably negligible when commonly accepted thresholds are used.”

Not everyone is convinced. David Knopman, MD, of the Mayo Clinic, worries that primary care physicians will totally abandon dementia screening. He tells MedPage Today that doctors should have a good reason to screen and should not do so just because a patient is old.

“On the other hand, if they detect that a person is making mistakes with medications, the person isn’t following their directions, the person is having more auto accidents than can be accounted for by chance....” — these are signs that should not be ignored.