- Evidence is insufficient to recommend for or against routine screening for cognitive impairment among asymptomatic community-dwelling older adults, the US Preventive Services Task Force (USPSTF) concludes.
- This recommendation is unchanged from 2014.
Why this matters
- Globally, almost 10 million new cases of dementia are diagnosed annually.
- Cognitive impairment often precedes dementia.
- Early identification could inform counseling, intervention.
- Editorial notes political pressures from commercial interests and patient advocacy groups for routine screening and calls for evidence-based practices.
- Second editorial notes that newly available therapies might add weight to the benefits of screening.
- Evidence is insufficient for assessing benefits vs harms of screening for cognitive impairment in asymptomatic members of this population.
- Screening tools generally have lower sensitivity, specificity for detecting mild cognitive impairment vs dementia.
- Domains lacking evidence of benefit:
- Medications, supplements that improve long-term outcomes.
- Interventions that support caregivers.
- Favorable changes in decision-making, planning.
- Domains lacking evidence of harm:
- Psychosocial detriment.
- Medication adverse effects.
- A US family physician association supports the 2014 recommendation.
- However, the American Academy of Neurology recommends assessment for cognitive impairment at annual wellness visits.
- Updated evidence report, systematic review of 287 studies, >285,000 older adults.
- Funding: Agency for Healthcare Research and Quality.
- Inconsistent definitions, reporting of outcomes.
- Not applicable to individuals hospitalized or living in group facilities.