"We have failed to find sufficient evidence to recommend for or against routinely screening older adults for dementia," says Dr. Alfred O. Berg, chairman of the U.S. Preventive Task Force.
The task force is an independent panel of private-sector experts who assess evidence for a wide range of preventive services. The panel's recommendations are considered the standard of care. Its work is sponsored by the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services.
Unfortunately, Berg cautions, doctors are going to have to decide on their own what to do without having clear scientific evidence.
The medical evidence for the task force recommendation comes from a report from a team led by Dr. Malaz Boustani, an assistant professor of medicine at the Indiana University School of Medicine.
Boustani's team reviewed all the literature on dementia screening from 1994 onward. "We found that there was not enough data to decide whether the benefit of screening outweighed the potential harms of screening," Boustani says. Their report appears in the June 3 issue of the Annals of Internal Medicine.
Routine screening of patients with no signs of dementia can be risky, Berg says. Patients might test positive for dementia but not actually have the problem, which can have a devastating psychological effect. And patients with dementia could have normal test results, he says.
Boustani adds that patients with no signs of dementia but who are diagnosed with dementia might suffer consequences such as canceled health insurance or revoked driver's licenses.
Boustani says that randomized trials are going on to see whether routine screening might be beneficial. He notes that in one trial, most of the patients who were screened positive for dementia did not want to come back for further evaluation. He suspects that fear may be the reason.
Should the results of these trials show a significant benefit from screening, the recommendations of the task force might change, Boustani says.
The only benefit that Boustani sees from screening is that patients and their families can begin to make health-care arrangements and decisions about finances and other personal matters.
Boustani stresses that if family members or your doctor notes signs of memory loss or other cognitive problems, the patient should be tested for dementia.
"There is no effective cure for dementia even when you find it," Berg adds. "Treatments may slow progression but they do not reverse the condition." If there were treatments, routine screening might be worthwhile, he notes.
However, Berg says, doctors should be alert for signs of cognitive disorders among their patients. But as a patient, "you should not expect that your physician should be giving you a routine mental status exam."
Dr. Sharon Inouye, a professor of medicine specializing in dementia from Yale University, calls the new recommendations "disappointing." She says she "would like to see more screening done in the older population because dementia is so often missed, particularly in its early stages."
"These guidelines don't increase the recognition of the problem, but I understand the problem that the evidence in the literature is not good. Geriatric investigators need to concentrate on getting better evidence so we can document the need for more widespread screening," Inouye says.
She also says there is need to document the value of early treatment. There is some good evidence, Inouye notes, that medications can slow the progression of dementia for several months. "The benefit is mild, but if patients are not diagnosed early than they lose out on this benefit altogether. I would hate to deny a significant number of people this potential benefit," she says.