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

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

  • curated by Susan London
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.


  • 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.


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