Jennifer S. Lin, MD, MCR; Elizabeth O’Connor, PhD; Rebecca C. Rossom, MD, MCR; Leslie A. Perdue, MPH; Elizabeth Eckstrom, MD, MPH
Acknowledgment: The authors thank Matthew Thompson, MD, MPH, DPhil, for his assistance with the introduction to the full evidence report; Mary Ganguli, MD, MPH, for her expert advice on MCI; Patricia G. Archbold, DNSc, RN, and Barbara J. Stewart, PhD, for their advice on caregiver interventions and outcome measures; Brittany Burda, MPH, for her assistance on data abstraction and preparation of this manuscript; Clara Soh, MPA, and Carin Olson, MD, for their assistance in data abstraction; Daphne Plaut, MLS, for creating and conducting the literature searches; Kevin Lutz, MFA, for his editorial assistance; the AHRQ staff; members of the USPSTF; and Soo Borson, MD, Katie Maslow, MSW, Riley McCarten, MD, Parminder Raina, PhD, Raj Shah, MD, Joseph Chin, MD, MS, Kurt Greenlund, PhD, and Susan Cooley, PhD, for their feedback on an early version of the evidence report.
Financial Support: This review was conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center under contract to AHRQ, Rockville, Maryland (contract HHS-290-2007-10057-I). AHRQ staff provided oversight for the project and assisted in external review of the companion draft evidence synthesis.
Potential Conflicts of Interest: Dr. Lin: Grant (money to institution): AHRQ; Support for travel to meetings for the study or other purposes (money to institution): AHRQ; Payment for writing or reviewing the manuscript (money to institution): AHRQ; Provision of writing assistance, medicines, equipment, or administrative support (money to institution): AHRQ. Dr. O’Connor: Grant: AHRQ. Dr. Rossom: Grant: AHRQ. Ms. Perdue: Grant: AHRQ. Dr. Eckstrom: Grant: AHRQ. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1466.
Requests for Single Reprints: Reprints are available from the AHRQ Web site ( www.ahrq.gov).
This article was published online first at www.annals.org on 29 October 2013.
Current Author Addresses: Drs. Lin and O’Connor and Ms. Perdue: Kaiser Permanente Center for Health Research Northwest, 3800 North Interstate Avenue, Portland, OR 97227.
Dr. Rossom: HealthPartners, 8170 33rd Avenue South, Minneapolis, MN 55440.
Dr. Eckstrom: Oregon Health & Science University, 3181 SW Sam Jackson Parkway, Department of Medicine L475, Portland, OR 97239.
Author Contributions: Conception and design: J.S. Lin, E. Eckstrom.
Analysis and interpretation of the data: J.S. Lin, E. O’Connor, R.C. Rossom, L.A. Perdue, E. Eckstrom.
Drafting of the article: J.S. Lin, E. O’Connor, R.C. Rossom.
Critical revision of the article for important intellectual content: J.S. Lin, E. O’Connor, R.C. Rossom, E. Eckstrom.
Final approval of the article: J.S. Lin, E. O’Connor, R.C. Rossom, L.A. Perdue, E. Eckstrom.
Statistical expertise: E. O’Connor.
Administrative, technical, or logistic support: L.A. Perdue.
Collection and assembly of data: J.S. Lin, E. O’Connor, R.C. Rossom, L.A. Perdue, E. Eckstrom.
This article has been corrected. The original version (PDF) is appended to this article as a supplement.
Earlier identification of cognitive impairment may reduce patient and caregiver morbidity.
To systematically review the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment.
MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through December 2012; systematic reviews; clinical trial registries; and experts.
English-language studies of fair to good quality, primary care–feasible screening instruments, and treatments aimed at persons with mild cognitive impairment or mild to moderate dementia.
Dual quality assessment and abstraction of relevant study details.
The Mini-Mental State Examination (k = 25) is the most thoroughly studied instrument but is not available for use without cost. Publicly available instruments with adequate test performance to detect dementia include the Clock Drawing Test (k = 7), Mini-Cog (k = 4), Memory Impairment Screen (k = 5), Abbreviated Mental Test (k = 4), Short Portable Mental Status Questionnaire (k = 4), Free and Cued Selective Reminding Test (k = 2), 7-Minute Screen (k = 2), and Informant Questionnaire on Cognitive Decline in the Elderly (k = 5). Medications approved by the U.S. Food and Drug Administration for Alzheimer disease (k = 58) and caregiver interventions (k = 59) show a small benefit of uncertain clinical importance for patients and their caregivers. Small benefits are also limited by common adverse effects of acetylcholinesterase inhibitors and limited availability of complex caregiver interventions. Although promising, cognitive stimulation (k = 6) and exercise (k = 10) have limited evidence to support their use in persons with mild to moderate dementia or mild cognitive impairment.
Limited studies in persons with dementia other than Alzheimer disease and sparse reporting of important health outcomes.
Brief instruments to screen for cognitive impairment can adequately detect dementia, but there is no empirical evidence that screening improves decision making. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear.
Agency for Healthcare Research and Quality.
Lin JS, O’Connor E, Rossom RC, et al. Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159:601–612. doi: https://doi.org/10.7326/0003-4819-159-9-201311050-00730
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Published: Ann Intern Med. 2013;159(9):601-612.
Geriatric Medicine, Prevention/Screening.
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