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The U.S. Preventive Services Task Force has found insufficient evidence to recommend for or against routine screening for dementia in older adults. However, the Task Force notes that primary care clinicians should remain alert to signs of dementia whenever deterioration is suspected based on direct observation, patient report, or concerns raised by family members, friends, or caretakers. The Task Force recommendation appears in the June 3, 2003, issue of the Annals of Internal Medicine.
Dementia is a progressive brain dysfunction. Symptoms of dementia include loss of recent memory, difficulty performing familiar tasks, problems with words, confusion about time and place, poor judgment, problems with abstract thinking, changes in mood and personality, and loss of initiative. In its review of screening for dementia in the primary care setting, the Task Force found:
- Good evidence shows that some screening tests can successfully detect dementia. However, age and education of the patient affect the accuracy and interpretation of some tests, producing misleading results.
- Medications such as cholinesterase inhibitors can slow the rate of decline in cognitive function, but the evidence is less clear on their ability to improve key activities of daily life.
- The evidence is insufficient to determine whether the benefits observed in drug trials conducted in specialized neurological clinics can be generalized to patients in primary care settings.
- No data are available to assess the potential harms of dementia screening, such as social stigma, depression, and anxiety.
Dementia results from destruction of brain cells most often caused by Alzheimer's disease. People over age 65 are most at risk for dementia. Studies show that 3 percent to 11 percent of people over age 65 and 25 percent to 47 percent of people over age 85 have evidence of dementia. Between 60 percent and 70 percent of patients with dementia have Alzheimer's disease. The siblings and children of patients with Alzheimer's disease have twice the risk for the disease compared with the risk for the general public. Hypertension and other cardiovascular risk factors also can be associated with increased risk for dementia.
There is no way to prevent or cure dementia, leading many to question the potential benefits of earlier detection. Early detection of dementia could be beneficial if it led to improved treatment through informed decisionmaking and use of medications to slow progression of the disease. However, the evidence supporting these potential benefits is of poor quality, and patients still face a risk of potential harms such as needless anxiety from false-positive test results. Thus, the Task Force found that more research is needed to determine whether any benefits of screening outweigh the potential harms.
The AHRQ-sponsored Task Force, the leading independent panel of private-sector experts in prevention and primary care, conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on a report prepared by a team of researchers led by Malaz Boustani, M.D., M.P.H., from AHRQ's Evidence-based Practice Center at RTI/University of North Carolina at Chapel Hill.
The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against) or "I" (insufficient evidence to recommend for or against screening). The Task Force found insufficient evidence to recommend for or against routine screening for dementia in older adults ("I" recommendation). This recommendation is very similar to the 1996 Task Force recommendation that found insufficient evidence to recommend for or against screening for dementia with standardized instruments in asymptomatic persons.
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Clinical information is also available from the National Guideline Clearinghouse™.
Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are also available online at http://www.ahrq.gov/clinic/uspstf/uspstopics.htm.
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