Jury Still Out on Routine Dementia Screening for Seniors
Panel says benefits unproven, but Alzheimer's experts say early detection is important
By Steven Reinberg
MONDAY, March 24, 2014 (HealthDay News) -- There's not yet enough evidence to support screening all older adults for dementia or a less severe condition called "mild cognitive impairment," according to a statement released Monday by the influential U.S. Preventive Services Task Force.
Mild cognitive impairment is a type of mental decline that does not interfere with activities of daily life.
General screening tests for dementia typically involve health professionals asking patients to perform a series of tasks to assess memory, attention, language, and visual-spatial and executive function.
"We found there wasn't sufficient evidence to recommend for or against screening," said task force member Dr. Douglas Owens, a professor of medicine at Stanford University's Center for Health Policy.
"This recommendation applies to people who are completely free of symptoms," Owens said. "If someone has symptoms, they should be evaluated -- that's not screening in the sense we are talking about. We are talking about screening for people who have no symptoms whatsoever."
Screening all older adults for dementia or mild cognitive impairment would only be worthwhile if there were meaningful treatments, Owens said.
"There would need to be interventions that you can do where the benefits would outweigh the harms," he said.
Currently, the benefits of available treatments are "modest to small," Owens said, "and how important those are clinically is uncertain."
More research is needed on how early detection of mental decline could help older adults, their families and their doctors, Owens said.
The new statement, published online March 24 in the journal Annals of Internal Medicine, is the final recommendation, and updates the task force's draft recommendation released in November 2013.
One expert, however, suggested that the task force's recommendation is dodging a very important issue -- an epidemic of dementia.
"Like Medicare's decision not to cover [a brain scan for Alzheimer's], the bottom line here is a cost-effectiveness analysis," said Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City. "In other words, since we have no effective treatment, we should not spend money on proactive diagnosis of dementia," he said.
Nicole Raisch, a spokeswoman for the USPSTF, took issue with Gandy's statement, however.
"The Task Force's recommendations are based solely on an assessment of the evidence, weighing both the benefits and harms of a preventive service," she said. "The Task Force does not consider the costs of providing a service in its appraisal of the effectiveness of a preventive service."
According to Gandy, many doctors avoid diagnosing dementia because, among other reasons, discussion of a dementia diagnosis with patients and family "is time consuming and the outlook is hopeless."
"The task force's advice that we look the other way can be interpreted as providing justification for this practice and misses an opportunity to elevate the conversation on dementia," he said.