According to the United States Preventive Services Task Force (USPSTF), routine screening of older individuals for cognitive loss is not supported by current guidelines. Researchers reviewed 55 studies that examined the accuracy of screening systems, as well as 130 studies of interventions aiming at slowing or stopping cognitive dysfunction in patients who tested positive for cognitive loss.
So far, researchers report that acetylcholinesterase inhibitors may have a small effect on cognitive function, but the overall benefit can’t be established at this time. Nonpharmacological interventions were evaluated as well, and no data was found to be consistent. However, those trials that showed some benefit were not overly significant statistically.
Researchers from Baylor College of Medicine in Houston, Texas report that they found insufficient evidence to draw a conclusion about the balance between benefits and risks of screening. Panel members noted that evidence for harm was lacking as well, but would certainly include drug side effects. Despite new research into cognitive screening and interventions since 2003, the overall conclusion remained the same. However, of note is that the task force emphasized that the review covered only routine, universal screening for older patients without clear signs or symptoms of cognitive impairment. A literature review previously also found no clear evidence for a benefit from dementia screening. Nevertheless, the above statement is at odds with the Alzheimer’s Association guideline on screening. At this point, Medicare is covering cognitive screening for beneficiaries as part of the “Annual Wellness Visit,” a new initiative of the Affordable Care Act, also commonly referred to as Obamacare.
It’s worth noting that the American Geriatrics Society as taken no position on cognitive screening in the absence of patient or caregiver complaints. Nevertheless, the society feels that there are certain assessments and management therapies for patients selected for screening. According to MedPage Today, Huntington Potter, PhD, an Alzheimer’s disease specialist at the University of Colorado in Denver, said that screening can have value, but the decision to screen a patient has to be individualized. Porter goes on to say that screening can help patients take steps to reduce the chance of progression to more serious impairment: “They can begin to change their lifestyle, perhaps reduce their cholesterol which will help reduce their risk for dementia later on, perhaps get more exercise.”
Ultimately, the task force, led by chair Virginia Moyer, MD, MPH, of Baylor College of Medicine in Houston, summarized the findings by indicating insufficient evidence to draw a conclusion about the balance between and risks of screening.