The U.S. Preventive Services Task Force issued recommendations on Tuesday on the value of routine cognitive screening for older adults, concluding “the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment.”
The task force said there was inadequate direct evidence on the benefits, and that several drug therapies and non-pharmacologic interventions have a “small effect” on the short term cognitive function measures in patients with mild to moderate dementia. They said the extent of clinically relevant benefit is uncertain. This is the same conclusion reached in previous assessments of the clinical benefit of cognitive screening.
They did find evidence that interventions targeted to caregivers have a small effect on caregiver burden and depression, but the scope of clinical relevance is still uncertain. 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 and have no signs or symptoms of cognitive impairment. Early detection and diagnosis of dementia through the assessment of patient-, family-, or physician-recognized signs and symptoms, some of which may be subtle, are not considered screening and are not the focus of this recommendation.
Despite the lack of clinical evidence on benefits of routine screening, the USPSTF said clinicians should still be alert for any signs or symptoms of cognitive impairment in their patients and conduct evaluations as appropriate. Routine cognitive screening is covered by Medicare under provisions of the Affordable Care Act. The Alzheimer’s Association recommends the use of a brief structured assessment if signs or symptoms of cognitive impairment are present or if an informant is not available to confirm the absence of signs or symptoms.