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Task Force Questions Dementia Screening

In a recent report, the U.S. Preventive Services Task Force (USPSTF) maintained that there is not enough evidence to recommend for or against screening for mild cognitive impairment (MCI) — dementia that does not interfere with the activities of daily life.

The Alzheimer’s Association has a different view. “Routine cognitive assessments are not screening, but are a way to detect change over time that could indicate underlying pathology,” Maria Carrillo, PhD, vice president for medical and scientific relations at the Alzheimer’s Association, told Medscape.

The USPSTF recommendation reiterates one it made in 2003, in which it said the same thing about dementia screening. The updated version, published March 25 in the Annals of Internal Medicine, looked at people 65 and older who are treated by primary care physicians and who have no symptoms of cognitive decline.

Screenings assess a patient’s memory, attention, language, and “visuospatial or executive functioning.”

The USPSTF determined that even if screening works, there’s not enough evidence that treatments would help, because “pharmacologic treatments result in small benefits of unknown clinical significance.”

Dementia affects approximately 2.4 to 5.5 million Americans, and its prevalence increases with age.

Estimated prevalence of mild cognitive impairment

“It is difficult to estimate the prevalence of MCI,” the USPSTF authors wrote, “and estimates range widely, from 3% to 42% in adults aged 65 and older.”

Dementia cost the health care system about $183 billion in 2011, with Medicare and Medicaid footing about 40% to 70% of that. “These costs do not include the estimated $202 billion in uncompensated care that informal caregivers provide annually,” according to the study.

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