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Routine Dementia Screening Doesn't Make Sense

Researchers report test inaccuracies, lack of treatments outweigh benefits

FRIDAY, July 8, 2005 (HealthDay News) -- It sounds like a good idea: As baby boomers become senior citizens, screen them for signs of dementia after age 65.

But a new study suggests that routine testing is more trouble than it's worth.

Researchers found that half of those who showed signs of dementia during doctor's office visits failed to return for follow-up tests. Many of those who did come back turned out to be fine or just experiencing slight cognitive problems.

To make things even more challenging, doctors can't fully treat symptoms of dementia -- including failing memory, personality changes and difficulty comprehending the world -- even if they do discover them.

All in all, "we're not ready" for routine screening, said study author Dr. Malaz Boustani, an assistant professor of medicine at Indiana University. "We need to work on our system to make it ready."

Doctors expect the number of American patients with dementia to rise as the baby boomer generation ages. Dementia, sometimes described by the general term senility, is often caused by Alzheimer's disease, which has no cure.

In the new study, researchers developed a dementia test and screened 3,340 patients aged 65 and older at doctors' offices in Indianapolis. The findings appear in the July issue of the Journal of General Internal Medicine.

Thirteen percent of the patients showed signs of dementia, but only about half of those agreed to come back for more tests. It's possible that the patients who didn't return feared getting a dementia diagnosis, Boustani said. "They're scared; they think there's a stigma to having dementia."

Of those who did return, 47 percent were diagnosed with dementia, while 33 percent had some cognitive impairment, but no dementia. And 20 percent were fine.

The researchers estimated that each test cost $128, and doctors needed to spend an average $3,983 on tests before a single patient is diagnosed with dementia.

The cost of the screening test and its lack of accuracy are major problems, Boustani said, and the lack of potential treatments makes screening even less effective. For now, he said, doctors should wait to do anything until their patients actually show signs of dementia.

In theory, however, routine screening tests remain a good idea, said Dr. Charles Ettari, medical director of the geriatric psychiatry unit at Scripps Mercy Hospital in San Diego. While it's impossible to cure Alzheimer's disease, drugs can help patients hold off its worst effects when it's caught early, he said.

"We can push the signs and symptoms of dementia farther out into the future," he said. "Instead of getting it next year, you'll get it many years in the future."

More information

Learn more about dementia from the National Institute on Aging.

SOURCES: Malaz Boustani, M.D., M.P.H., assistant professor, medicine, Indiana University, Indianapolis; Charles Ettari, M.D., medical director, geriatric psychiatry unit, Scripps Mercy Hospital, San Diego, Calif.; July 2005 Journal of General Internal Medicine
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