Malaz Boustani, MD, MPH; Britt Peterson, MD, MPH; Laura Hanson, MD, MPH; Russell Harris, MD, MPH; Kathleen N. Lohr, PhD
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank their liaisons from the U.S. Preventive Services Task ForceCynthia Mulrow, MD, MSc, The University of Texas Health Science Center, San Antonio, Texas, and Albert Siu, MD, MSPH, Mount Sinai Medical Center, New York, New Yorkfor their assistance with the full systematic evidence review. They also thank David Atkins, MD, MPH, Director, Agency for Healthcare Research and Quality Clinical Prevention Program, for his advice and counsel and Sonya Sutton, BSPH, and Loraine Monroe (both of RTI) and Carol Krasnov and Audrina Bunton (both of the University of North Carolina) for their assistance.
Grant Support: This study was conducted by the RTIUniversity of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Maryland (contract no. 290-97-0011, task order 3). Dr. Boustani has received career development support from the Program on Aging, John A. Hartford Foundation, and the American Federation for Aging Research.
Potential Financial Conflicts of Interest:Grants received: M. Boustani (Pfizer, Inc.).
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Current Author Addresses: Dr. Boustani: Regenstrief Institute, Inc., 1050 Wishard Boulevard, RG 6, Indianapolis, IN 46202-2872.
Dr. Peterson: University of North Carolina at Chapel Hill, 706C Hibbard Drive, Chapel Hill, NC 27514.
Dr. Hanson: University of North Carolina at Chapel Hill, 258 Macnider, CB #7110, Chapel Hill, NC 27599.
Dr. Harris: Sheps Center for Health Services Research, 725 Airport Road, CB #7590, Chapel Hill, NC 27599-2949.
Dr. Lohr: RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709.
Dementia is a large and growing problem but is often not diagnosed in its earlier stages. Screening and earlier treatment could reduce the burden of suffering of this syndrome.
To review the evidence of benefits and harms of screening for and earlier treatment of dementia.
MEDLINE, PsycINFO, EMBASE, the Cochrane Library, experts, and bibliographies of reviews.
The authors developed eight key questions representing a logical chain between screening and improved health outcomes, along with eligibility criteria for admissible evidence for each question. Admissible evidence was obtained by searching the data sources.
Two reviewers abstracted relevant information using standardized abstraction forms and graded article quality according to U.S. Preventive Services Task Force criteria.
No randomized, controlled trial of screening for dementia has been completed. Brief screening tools can detect some persons with early dementia (positive predictive value 50%). Six to 12 months of treatment with cholinesterase inhibitors modestly slows the decline of cognitive and global clinical change scores in some patients with mild to moderate Alzheimer disease. Function is minimally affected, and fewer than 20% of patients stop taking cholinesterase inhibitors because of side effects. Only limited evidence indicates that any other pharmacologic or nonpharmacologic intervention slows decline in persons with early dementia. Although intensive multicomponent caregiver interventions may delay nursing home placement of patients who have caregivers, the relevance of this finding for persons who do not yet have caregivers is uncertain. Other potential benefits and harms of screening have not been studied.
Screening tests can detect undiagnosed dementia. In persons with mild to moderate clinically detected Alzheimer disease, cholinesterase inhibitors are somewhat effective in slowing cognitive decline. The effect of cholinesterase inhibitors or other treatments on persons with dementia detected by screening is uncertain.
Table 1. Key Questions, Eligibility Criteria, and Number of Articles Meeting Criteria
Table 2. Estimates of Undiagnosed Dementia in Primary Care Practices
Table 3. Accuracy of Screening Tests for Dementia
Table 4. Efficacy of Cholinesterase Inhibitors in Patients with Alzheimer Disease after 3 to 12 Months
Table 5. Summary of Efficacy of Caregiver Interventions
Appendix Table 1. Key Questions for Screening for Dementia Syndrome
Analytic framework for screening for dementia.
Appendix Table 2. Dementia Syndrome: Eligibility Criteria, Search Strategy, and Results of Searches
Selection of articles for key question 1: direct evidence.
Selecting articles for key question 2: prevalence of undiagnosed dementia.
Selecting articles for key question 3: accuracy of screening tests.
Selecting articles for key question 4: efficacy of pharmacologic treatment.
Selecting articles for key question 5: efficacy of nonpharmacologic treatment.
Selecting articles for key question 6: interventions for planning.
Selecting articles for key questions 7 and 8: harms of screening and treatment.
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Boustani M, Peterson B, Hanson L, et al. Screening for Dementia in Primary Care: A Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;138:927–937. doi: 10.7326/0003-4819-138-11-200306030-00015
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Published: Ann Intern Med. 2003;138(11):927-937.
Dementia, Guidelines, Neurology, Prevention/Screening.
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