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More research needed on universal screening for cognitive impairment


By Rachel Landen
Posted: March 24, 2014 - 7:45 pm ET
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The U.S. Preventive Services Task Force has declined to recommend screening of all older adults for cognitive impairment including dementia, saying not enough research evidence exists to support universal screening.

The report was published Monday in the Annals of Internal Medicine.

The task force, in reviewing the evidence, determined that it is unclear whether routine screening for cognitive impairment results in health improvements. It is uncertain whether the benefits of detecting the disease early outweigh the potential harms of treatment or labeling a person, said Dr. Kirsten Bibbins-Domingo, professor of medicine at the University of California, San Francisco, and co-vice chairman of the task force.

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But Bibbins-Domingo cautioned that the recommendation on screening applies to people who do not show signs or symptoms of the disease. “If a patient, family member or clinician is concerned or notices symptoms, the clinician should continue to diagnose and treat them,” she said.

Cognitive impairment screening tests typically involve asking patients to perform tasks that evaluate memory, attention, language and visual-spatial or executive functioning. Estimates vary greatly as to how many adults age 65 and older have some kind of mild cognitive impairment, ranging from 3% to 42%. Dementia, which is a more severe form of cognitive impairment that makes it difficult to remember, speak, learn new things, concentrate or make decisions, affects between 2.4 million and 5.5 million Americans, and its prevalence rises with age. Alzheimer's disease is the best-known form of dementia.

The Alzheimer's Association released a statement last October supporting early detection and diagnosis of Alzheimer's in a medical setting, such as during an annual wellness visit. At that time, the association asked the task force to consider supporting establishment of a cognitive baseline for older adults with regular ongoing surveillance of their cognitive abilities.

Yet even though the task force did not recommend that, Bibbins-Domingo said its report is not a recommendation for or against screening, but rather a statement that more research evidence is needed. “We take our recommendations very seriously,” she said. “We oftentimes use them to shine a spotlight on an area that merits more research when we believe an issue is very important.”

The task force also has highlighted risk factors for dementia and made recommendations to prevent vascular disease, which is one risk factor. This includes smoking cessation, moderate alcohol consumption, a healthy diet, increased physical activity and early detection of hypertension and elevated cholesterol.

Follow Rachel Landen on Twitter: @MHrlanden


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