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

USPSTF: 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)

Relat­ed arti­cles and resources:

• Retool­ing Brain Care With Low-Cost, Data-Dri­ven Technologies
• Info­graph­ic on the Dig­i­tal Brain Health Mar­ket 2012–2020
• From Anti-Alzheimer’s ‘Mag­ic Bul­lets’ to True Brain Health