Jury still out on routine dementia screening for seniors

March 26, 2014 by Steven Reinberg, Healthday Reporter
Jury still out on routine dementia screening for seniors
Panel says benefits unproven, but Alzheimer's experts say early detection is important.

(HealthDay)—There's not yet enough evidence to support screening all older adults for dementia or a less severe condition called "mild cognitive impairment," according to a statement released Monday by the influential U.S. Preventive Services Task Force.

Mild cognitive impairment is a type of mental decline that does not interfere with activities of daily life.

General screening tests for dementia typically involve health professionals asking patients to perform a series of tasks to assess memory, attention, language, and visual-spatial and executive function.

"We found there wasn't sufficient evidence to recommend for or against screening," said member Dr. Douglas Owens, a professor of medicine at Stanford University's Center for Health Policy.

"This recommendation applies to people who are completely free of symptoms," Owens said. "If someone has symptoms, they should be evaluated—that's not screening in the sense we are talking about. We are talking about screening for people who have no symptoms whatsoever."

Screening all older adults for dementia or mild would only be worthwhile if there were meaningful treatments, Owens said.

"There would need to be interventions that you can do where the benefits would outweigh the harms," he said.

Currently, the benefits of available treatments are "modest to small," Owens said, "and how important those are clinically is uncertain."

More research is needed on how early detection of could help , their families and their doctors, Owens said.

The new statement, published online March 24 in the journal Annals of Internal Medicine, is the final recommendation, and updates the task force's draft recommendation released in November 2013.

One expert, however, suggested that the task force's recommendation is dodging a very important issue—an epidemic of dementia.

"Like Medicare's decision not to cover [a brain scan for Alzheimer's], the bottom line here is a cost-effectiveness analysis," said Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City. "In other words, since we have no effective treatment, we should not spend money on proactive diagnosis of dementia," he said.

Nicole Raisch, a spokeswoman for the USPSTF, took issue with Gandy's statement, however.

"The Task Force's recommendations are based solely on an assessment of the evidence, weighing both the benefits and harms of a preventive service," she said. "The Task Force does not consider the costs of providing a service in its appraisal of the effectiveness of a preventive service."

According to Gandy, many doctors avoid diagnosing dementia because, among other reasons, discussion of a dementia diagnosis with patients and family "is time consuming and the outlook is hopeless."

"The task force's advice that we look the other way can be interpreted as providing justification for this practice and misses an opportunity to elevate the conversation on dementia," he said.

Gandy said a recent report found that Alzheimer's may kill six times as many people as previously believed.

"This figure came as no surprise to dementia specialists," he said. "As long as primary-care physicians and other professionals fail to confront the epidemic status of dementia, the more time will be required before governments take seriously the economic threat of the dementia epidemic."

Heather Snyder, director of medical and scientific operations at the Alzheimer's Association, said there is value in detecting dementia early, despite the task force's stance.

"Their recommendation is that they can't make a recommendation," she said. "It's very important to separate insufficient evidence from no evidence."

The Alzheimer's Association supports early detection and diagnosis of Alzheimer's, Snyder said. "We know there is a better chance that an individual would be able to benefit from the current medications that are available," she said. "They would be able to take advantage of clinical trials and participate in conversations with their family about planning for their care and financial future."

According to the task force, dementia affects approximately 2.4 million to 5.5 million Americans. It results in trouble remembering, speaking, learning new things, concentrating and making decisions that affect daily life.

Alzheimer's disease is one type of dementia. Mental decline is not always as severe as Alzheimer's.

A recent study, published in the March/April edition of the journal Annals of Family Medicine, found that only about 20 percent of people who experience will go on to develop serious brain-related disorders such as Alzheimer's.

Although some people will be stricken with Alzheimer's or other , many will see their symptoms remain the same or disappear, the researchers said.

The U.S. Preventive Services Task Force is an independent, volunteer panel of experts in prevention- and evidence-based medicine. It makes recommendations about clinical preventive services such as screenings, counseling and medications.

Explore further: USPSTF: Evidence lacking for cognitive impairment screening

More information: For more about dementia, visit the U.S. National Library of Medicine.

Related Stories

USPSTF: Evidence lacking for cognitive impairment screening

November 5, 2013
(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) has found that the evidence is insufficient to assess the balance of benefits and harms of cognitive impairment screening for older adults without signs or symptoms ...

USPSTF: Evidence lacking for cognitive impairment testing

October 22, 2013
(HealthDay)—Screening instruments can detect dementia but there is insufficient evidence to determine the clinical effect of screening and interventions, according to a review conducted for the U.S. Preventive Services ...

No routine mental tests for seniors—at least not yet, panel says

November 5, 2013
(HealthDay)—Physicians give screening tests to older adults who show signs of mental decline, and some experts have theorized that all seniors might benefit from routine memory testing. But proposed guidelines from a U.S. ...

USPSTF identifies high priority evidence gaps for older adults

November 20, 2013
(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) has produced their third annual report for Congress identifying high-priority evidence gaps specifically relating to the care of older adults.

About one-quarter of patients with MCI progress to dementia

March 12, 2014
(HealthDay)—About 22 percent of patients with mild cognitive impairment (MCI) progress to dementia within three years, and depression symptoms modify the prognosis, according to a study published in the March/April issue ...

Alzheimer's prevention trial to evaluate, monitor participants' reactions to learning of higher disease risk status

March 19, 2014
A new clinical trial will soon begin testing whether early medical intervention in people at risk for Alzheimer's can slow down progression of disease pathology before symptoms emerge, as outlined in Science Translational ...

Recommended for you

Lifestyle changes to stave off Alzheimer's? Hints, no proof

July 20, 2017
There are no proven ways to stave off Alzheimer's, but a new report raises the prospect that avoiding nine key risks starting in childhood just might delay or even prevent about a third of dementia cases around the world.

Blood test identifies key Alzheimer's marker

July 19, 2017
A new study led by researchers at Washington University School of Medicine in St. Louis suggests that measures of amyloid beta in the blood have the potential to help identify people with altered levels of amyloid in their ...

Steering an enzyme's 'scissors' shows potential for stopping Alzheimer's disease

July 19, 2017
The old real estate adage about "location, location, location" might also apply to the biochemical genesis of Alzheimer's disease, according to new research from the University of British Columbia.

Brain scans may change care for some people with memory loss

July 19, 2017
Does it really take an expensive brain scan to diagnose Alzheimer's? Not everybody needs one but new research suggests that for a surprising number of patients whose memory problems are hard to pin down, PET scans may lead ...

Can poor sleep boost odds for Alzheimer's?

July 18, 2017
(HealthDay)— Breathing problems during sleep may signal an increased risk for Alzheimer's disease, a trio of studies suggests.

Hearing is believing: Speech may be a clue to mental decline

July 17, 2017
Your speech may, um, help reveal if you're uh ... developing thinking problems. More pauses, filler words and other verbal changes might be an early sign of mental decline, which can lead to Alzheimer's disease, a study suggests.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.