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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Screening for Dementia in Primary Care Settings
3 June 2003 | Volume 138 Issue 11 | Page I-60
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full reports titled "Screening for Dementia: Recommendation and Rationale" and "Screening for Dementia in Primary Care: A Summary of the Evidence for the U.S. Preventive Services Task Force." They are in the 3 June 2003 issue of Annals of Internal Medicine (volume 138, pages 925-926 and pages 927-937). The first report was written by the U.S. Preventive Services Task Force; the second report was written by M. Boustani, B. Peterson, L. Hanson, R. Harris, and K.N. Lohr.
What is the U.S. Preventive Services Task Force?
The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.
What is the problem and what is known about it so far?
Dementia is a condition that affects memory and thinking enough to interfere with normal daily activities. About 1 out of every 10 Americans older than 65 years of age has some degree of dementia. Poor memory alone is not dementia, and some declines in short-term memory are normal as people age. Several diseases can cause dementia, but the two most common are Alzheimer disease and cerebrovascular dementia. In Alzheimer disease, the buildup of abnormal proteins damages brain cells. In cerebrovascular dementia, low blood flow to the brain damages brain cells. There is no cure for dementia. However, drugs called cholinesterase inhibitors can modestly slow the worsening of disease. Also, some nondrug management strategies might be useful in delaying the need for nursing home care. Doctors should consider a diagnosis of dementia if a patient reports problems with memory and thinking. However, it is unclear whether it makes sense for primary care doctors to screen for dementia in patients who do not report these problems. Screening is looking for a specific condition in people who do not report symptoms of that condition.
How did the USPSTF develop these recommendations?
The USPSTF reviewed published research to evaluate the benefits and harms of screening primary care patients for dementia. For screening to make sense, several circumstances need to exist. First, the condition must be common. Second, there must be a good way to test for the condition. Third, treatment must be available. Fourth, patients treated early (before symptoms develop) must do better than patients treated later (after symptoms develop). Fifth, the potential harms of screening must not outweigh the benefits.
What did the USPSTF find?
The USPSTF authors found that no studies evaluated the benefits and harms of screening for dementia. They did find studies suggesting that brief examinations can detect dementia. However, only about half of the people who have positive results on brief examinations actually have dementia confirmed by more rigorous tests. Studies show that treatment with cholinesterase inhibitors for 6 to 12 months can modestly slow the worsening of dementia but only minimally affects patient function. There is very limited information about other types of treatments for dementia. No good studies have addressed other potential benefits and harms of screening for this disorder.
What does the USPSTF suggest that patients do?
The USPSTF recommends neither for nor against screening for dementia in primary care patients who do not have symptoms of memory loss or confusion. If patients or their relatives notice memory problems, they should tell their doctors because testing for dementia might be reasonable in this situation.
What are the cautions related to these recommendations?
As better studies become available, the USPSTF may modify these recommendations.
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H. Brodaty, L.-F. Low, L. Gibson, and K. Burns What Is the Best Dementia Screening Instrument for General Practitioners to Use? Am J Geriatr Psychiatry, May 1, 2006; 14(5): 391 - 400. [Abstract] [Full Text] [PDF]
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 J. P Warner Insufficient evidence on benefits of early detection and treatment of dementia Evid. Based Ment. Health, November 1, 2003; 6(4): 108 - 108. [Full Text] [PDF]
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 OTHER ARTICLES NOTED (25 Apr 2003 to 18 Jul 2003) Evid. Based Nurs., October 1, 2003; 6(4): e1 - 12. [Full Text]
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