Proposed Guidelines Do Not Support Cognitive Screening for All Older Adults

Dorian Martin Health Guide
  • My 88-year-old father’s memory for the most part is good. So should he and other elders who are not showing signs of memory loss be screened for dementia? An influential group has proposed recommendations that would discourage this screening for all older adults in the United States.  Currently, most physicians – with the exception of neurologists or psychiatrists – don’t screen their patients for cognitive issues.

    The guidelines for dementia screening being proposed by this group, the U.S. Preventive Services Task Force, point out that not enough evidence exists in the research base to support using cognitive screening tests with all older adults, not only with those who are showing signs of cognitive decline. These guidelines are updating previous recommendations made in 2003. A final decision will be made in December.

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    The task force systematically reviewed the literature on the accuracy of brief cognitive screening instruments as well as the effects of drug treatments and non-drug-related interventions for early cognitive impairment.  The researchers found that only 12 brief instruments had been researched more than once in well-designed studies. The Mini-Mental State Examination is actually the most researched screening instrument in determining accuracy, but this test can’t be used without cost. However, there are some free instruments that have been found by researchers to be adequate assessments in detecting dementia. These assessments include the Clock Drawing Test, the Mini-Cog, the Memory Impairment Screen, the Abbreviated Mental Test, the Short Portable Mental Status Questionnaire, Free and Cued Selective Reminding Test, the 7-Minute Screen, and the informant Questionnaire on Cognitive Decline in the Elderly.

    In this review, the task force focused on five key questions:

    • Does screening all older adults for cognitive impairment during their visits with their primary care physicians improve decision-making as well as patient, family, caregiver and/or societal outcomes?
    • How well do the screening instruments perform to detect cognitive impairment in the elderly?
    • What harm can come from screening for cognitive impairment?
    • Do interventions for older adults who have been diagnosed with mild cognitive impairment or mild to moderate dementia improve decision-making, or patient, family, caregiver or societal outcomes?
    • What harms exist due to interventions for cognitive impairment?

    The task force didn’t find any research that looked at whether screening for cognitive impairment as part of a visit with their primary care physician could affect either decision-making or patient, family, caregiver or societal outcomes. This review also didn’t identify any studies that directly addressed whether there were adverse psychological effects caused by the screening itself or adverse effects that came from false-positive or false-negative test results.

    The task force found that while research existed on medications approved by the Federal Drug Administration for use with Alzheimer’s disease, but this research suggested that these medications had only a small benefit for people who have mild cognitive impairment or mild or moderate dementia.  The task force also found limited evidence supporting other interventions such as cognitive stimulation or exercise in people with mild cognitive impairment or mild to moderate dementia.

  • Furthermore, little is known about the harm of screening.  Therefore, the task force is recommending more research on routine screenings is needed before this procedure is recommended to be administered to all elders, not just those who are showing some cognitive impairment.

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    The task force concluded that while brief instruments that screen patients for cognitive impairment can detect dementia, there isn’t any evidence that screening actually improves decision-making.  Furthermore, it is still unclear whether interventions for patients with dementia are significantly effective in persons whose cognitive impairment has been detected earlier.  However, these recommendations could change if researchers find a treatment that can prevent or stop dementia or delay its onset.

    Primary Sources for This Sharepost:

    Medline Plus. (2013). No routine mental tests for seniors – at least not yet, panel says.

    U.S. Preventive Services Task Force. (2013). Screening for cognitive impairment in older adults.

Published On: November 06, 2013