Routine screening for cognitive impairment in older adults: evidence falls short

  • Owens DK & al.
  • JAMA
  • 25 Feb 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • Updated evidence report, systematic review of 287 studies, >285,000 older adults.
  • Funding: Agency for Healthcare Research and Quality.

Limitations

  • Inconsistent definitions, reporting of outcomes.
  • Not applicable to individuals hospitalized or living in group facilities.