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The full report is titled “Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 3 June 2014 issue of Annals of Internal Medicine (volume 160, pages 791-797). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.
This article was published online first at www.annals.org on 25 March 2014.
Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;160:I-20. doi: 10.7326/P14-9017
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Published: Ann Intern Med. 2014;160(11):I-20.
The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of health experts that reviews published research and makes recommendations about preventive health care.
Cognitive impairment refers to problems with memory and thinking. Dementia is cognitive impairment that interferes with normal daily activities. Approximately 5 of every 100 Americans aged 71 to 79 years, 24 of every 100 Americans aged 80 to 89 years, and 37 of every 100 Americans aged 90 years or older have dementia. Poor memory alone is not dementia. Some decline in memory as people age is normal.
There is no cure for dementia. However, drugs may modestly slow its progression. Nondrug therapies may improve behavior and delay the need for nursing home care. Doctors should consider dementia if patients report problems with memory and thinking. However, it is unclear whether primary care doctors should screen for cognitive impairment in older patients if no such problems are reported.
In 2003, the USPSTF concluded that there was not enough known about the benefits and harms of screening for dementia in older adults and did not recommend for or against it. The USPSTF wanted to update the recommendation based on research published since 2003.
The USPSTF reviewed published research to evaluate the benefits and harms of screening for cognitive impairment.
No studies directly evaluated the benefits and harms of screening for cognitive impairment. Studies do show that screening tests can identify cognitive impairment. Some evidence shows that dementia drugs can slow cognitive impairment but not enough to meaningfully affect patient function. Few studies assessed nondrug therapies, and no studies evaluated the effect of screening on decision making by patients or their caregivers.
The potential harms of screening for cognitive impairment include the psychological effects of a cognitive impairment diagnosis and adverse effects of drugs that may be prescribed. Serious side effects include slow heart rate and falls.
The USPSTF concludes that not enough is known to make a recommendation about screening for cognitive impairment in older adults.
These recommendations apply only to older adults without noticeable problems with memory or thinking. If patients or their relatives notice memory problems, they should tell their doctors because testing for cognitive impairment may be indicated.
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Geriatric Medicine, Neurology, Dementia, Prevention/Screening.
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