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Brain health paradigm shift: from one-time screenings to regular cognitive assessments

Alzheimer_Word_cloud_conceptUSPSTF: No to Routine Screening for Cognitive Impairment (Medscape):

“There is insufficient evidence to recommend routine screening for cognitive decline in older adults in the primary care setting, according to a new review by the US Preventive Services Task Force (USPSTF)…The USPSTF reviewers looked at drug therapy and nondrug therapy options for cognitive impairment and found more evidence on both than at the 2003 review, but not enough evidence that they lead to better health outcomes.

Elaborating on the views of the Alzheimer’s Association, Maria Carrillo, PhD, vice president of medical and scientific relations, explained that “…no one should misconstrue this USPSTF guidance document to imply that there are no benefits to regular cognitive evaluations, or that regular evaluations are harmful…” She noted that the Alzheimer’s Association is not in favor of “1-time” screening — in which a brief test is conducted on 1 occasion — which it believes is associated with a high rate of false-positive and false-negative results. Rather, it advocates cognitive evaluation and regular follow-up assessments in a medical setting to establish a baseline and track change over time, such as through the Medicare Annual Wellness Visit. “Routine cognitive assessments are not screening, but are a way to detect change over time that could indicate underlying pathology,” Dr. Carrillo notes.

New clinical guidelines: Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement (Annals of Internal Medicine)

  • Description: Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for dementia.
  • Methods: The USPSTF reviewed the evidence on the benefits, harms, and sensitivity and specificity of screening instruments for cognitive impairment in older adults and the benefits and harms of commonly used treatment and management options for older adults with mild cognitive impairment or early dementia and their caregivers.
  • Population: This recommendation applies to universal screening with formal screening instruments in community-dwelling adults in the general primary care population who are older than 65 years and have no signs or symptoms of cognitive impairment.
  • Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment. (I statement)

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