Not Enough Evidence to Recommend Screening for Cognitive Impairment, USPSTF Says

According to a new review by the US Preventive Services Task Force (USPSTF), there is insufficient evidence to recommend routine screening for cognitive decline in older adults. This review is an update of a previous review, written in 2003, which found insufficient evidence to recommend for or against routine screening for dementia in older adults.



This current review looked at evidence on screenings for dementia and cognitive impairment, in adults 65 and older, who show no signs or symptoms of cognitive impairment. Included in the review were the benefits, harms, and test performance of screening instruments; as well as, benefits and harms of commonly used treatment and management options for older adults with mild cognitive impairment or early dementia.



Researchers concluded that evidence for screenings for cognitive impairment is lacking and the harms and benefits cannot be determined.  “It is very important for people to understand that ‘inadequate evidence of benefit’ of screening is not the same thing as evidence of no benefit,” Alzheimer’s Association pointed out in a statement in response to the USPSTF review.



Douglas K. Owens, MD, Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University, California and one of the authors of the review, told Medscape Medical News, “We couldn’t recommend for or against routine screening. But it is important to make the distinction that we are talking about asymptomatic individuals. If a person has concerns about their memory, they should be definitely be evaluated appropriately.”



He further explained that no evidence was found as to whether screenings would be helpful to people in understanding whether or not they need further evaluation. “But we don’t have evidence that routine use of these tests in everyone at a certain age leads to better outcomes.”



In addition, drug therapy and non-drug therapy for cognitive impairment did also not provide enough evidence that they lead to better outcomes. “For drug therapy, the benefits are modest and of uncertain clinical importance and the drugs have side effects,” Dr. Owens said. “And while non-drug therapy such as cognitive training can be useful in some circumstances, again evidence of benefit on long-term outcomes is lacking. In order to recommend routine screening we would need better evidence that this would lead to better health outcomes.”



Maria Carrillo, PhD, Vice President of Medical and Scientific Relations, explained to Medscape Medical News that “inadequate evidence of benefit” simply means there is not enough evidence to recommend or not recommend screenings for cognitive decline. “Therefore, 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,” Dr. Carrillo said. “As is made apparent by the USPSTF guidance document, more research is needed to develop better and simpler diagnostic tools, verify the NIA [National Institute on Aging]/Alzheimer’s Association new diagnostic criteria for Alzheimer’s disease, and confirm what experts are already telling us — that early detection leads to better outcomes and reduced costs.”



She notes that the Alzheimer’s Association does not promote the “1-time” screening idea, but advocates for cognitive evaluation and regular follow-up assessments in a medical setting. Dr. Carrillo notes, “Routine cognitive assessments are not screening, but are a way to detect change over time that could indicate underlying pathology.”



About 50% of people with Alzheimer’s and dementia never receive a formal diagnosis, and by the time a diagnosis is made, the disease has progressed significantly. “An early diagnosis allows people with Alzheimer’s disease or another dementia and their families a better chance of benefiting from available drug and nondrug therapies and more time to plan for the future.”






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