Doctors routinely recommend mammograms, colonoscopies and annual physicals to their patients. Should they also counsel that older adults, who are not symptomatic, be routinely screened in their doctor's office for dementia, a condition which affects about 1 in 10 Americans over the age of 65?
A report evaluating the wisdom of routine screening for dementia in primary care settings prepared for the U.S Preventative Services Task Force found that while two-thirds of dementia cases are undetected by the patient's primary care physician, insufficient data exists to indicate whether it is a good idea or not to administer dementia screening tests to patients who do not have symptoms of memory loss or confusion.
The authors of the report, led by Malaz Boustani, M.D., assistant professor of medicine at the Indiana University School of Medicine, research scientist at the Regenstrief Institute and the Indiana University Center For Aging Research, conducted a systemic evidence review of studies of dementia in older adults. The authors neither recommend for or against routine screening for dementia in older patients. This report and a companion USPSTF report are published in the June 3 issue of the Annals of Internal Medicine.
"No study has been published which has evaluated the likely benefits or detriments of dementia screening for individuals with no signs of the disease," said Dr. Boustani, who is a geriatrician and health services researcher. "We don't know enough to tell doctors to routinely screen their older patients for dementia. There is just not enough data to make the right decision on routine dementia screening."
He also is concerned that routine screening may lead to a high number of both false positive and false negative results. In the PREVENT study, a study led by Christopher Callahan, M.D., associate professor of medicine at the Indiana University School of Medicine, Regenstrief Institute research scientist and director of the Indiana University Center for Aging Research, a high number of false positives were discovered. In the study, which is looking at dementia in older adults, in-depth testing that followed routine screening revealed that 20 percent of individuals considered by their physicians to be demented were not.
The PREVENT study, which hopes to enroll 250 older adults and their caregivers, is a screening trial of the general population age 65 and older to assess the benefits or detriments of routine dementia screening.
According to Dr. Boustani, early diagnosis of Alzheimer disease might allow the medical community to intervene earlier to prescribe medications that may slow the initial course of the disease, to treat the depression which often accompanies dementia, to advise the patient to make advanced medical directives while he or she is still able to do so, as well as to help caregivers.
The downside of early diagnosis, he notes, includes the stigma of being labeled demented, possible employment and/or insurance discrimination, and depression in the patient and loved ones. While medications may stall the progression of the disease for several months, no intervention permanently halts the disease.
Dr. Boustani advises that if you or a loved one is having memory problems, the family physician should be notified , because your symptoms may be caused by depression, stroke, dementia or other conditions. If neither you nor a loved one have detected a problem, the current wisdom is that the value of being screened for dementia does not outweigh the potential harm to the patient.
To request a fax of the report, please contact the Annals of Internal Medicine at 1-800-523-1546, ext. 2656 or 215-351-2656.