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Press Release Date: June 2, 2003
The U.S. Preventive Services Task Force today said that the evidence is insufficient to recommend for or against routine screening for dementia in older adults. However, primary care clinicians should remain alert to signs of dementia whenever deterioration is suspected based on direct observation, patient report, or concerns raised by family members, friends, or caretakers. The Task Force recommendation appears in the June 3, 2003, issue of the Annals of Internal Medicine.
Dementia is a progressive brain dysfunction. Symptoms of dementia include loss of recent memory, difficulty performing familiar tasks, problems with words, confusion about time and place, poor judgment, problems with abstract thinking, changes in mood and personality, and loss of initiative. In its review of screening for dementia in the primary care setting, the Task Force found:
- Good evidence shows that some screening tests can successfully detect dementia. However, age and education of the patient affect the accuracy and interpretation of some tests, producing misleading results.
- Medications such as cholinesterase inhibitors can slow the rate of decline in cognitive function, but the evidence of their ability to improve key activities of daily life is less clear.
- The evidence is insufficient to determine whether the benefits observed in drug trials conducted in specialized neurological clinics can be generalized to patients in primary care settings.
- No data are available to assess the potential harms of dementia screening, such as social stigma, depression, and anxiety.
"Dementia is common in primary care practice and often unrecognized, but the Task Force did not find evidence that screening and early treatment makes an important difference in the lives of patients and their families," said Alfred O. Berg, M.D., M.P.H., chair of the Task Force. "Clearly we have much to learn about detecting and treating this devastating condition."
Dementia results from destruction of brain cells most often caused by Alzheimer's disease. People over age 65 are most at risk for dementia. Studies show that 3 percent to 11 percent of people over age 65 and 25 percent to 47 percent of people over age 85 have evidence of dementia. Between 60 percent and 70 percent of patients with dementia have Alzheimer's disease. The siblings and children of patients with Alzheimer's disease have twice the risk for the disease compared with the risk for the general public. Hypertension and other cardiovascular risk factors can also be associated with increased risk for dementia.
There is no effective prevention or cure for dementia, leading many to question the potential benefits of earlier detection. Early detection of dementia could be beneficial if it led to improved treatment through informed decisionmaking and use of medications to slow progression of the disease. However, the evidence supporting these potential benefits is of poor quality, and patients still face a risk of potential harms such as needless anxiety from false-positive test results. Thus, the Task Force found that more research is needed to determine whether any benefits of screening outweigh the potential harms.
The AHRQ-sponsored Task Force, the leading independent panel of private-sector experts in prevention and primary care, conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusion on a report from a team led by Malaz Boustani, M.D., M.P.H., from AHRQ's Evidence-based Practice Center at RTI/University of North Carolina at Chapel Hill.
The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against) or "I" (insufficient evidence to recommend for or against screening). The Task Force found insufficient evidence to recommend for or against routine screening for dementia in older adults ("I" recommendation). This recommendation is very similar to the 1996 Task Force recommendation that found insufficient evidence to recommend for or against screening for dementia with standardized instruments in asymptomatic persons.
The recommendations and materials for clinicians will be available online at http://www.uspreventiveservicestaskforce.org/3rduspstf/dementia/dementrr.htm. Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse by calling (800) 358-9295 or sending an E-mail to AHRQPubs@ahrq.hhs.gov. Clinical information is also available from the National Guideline Clearinghouse™ at http://www.guideline.gov.
Editor's Note: Please note that AHRQ is moving to a new location. Effective June 16, 2003, we will move to the:
John M. Eisenberg Building
540 Gaither Road
Rockville, MD 20850
For more information, please contact AHRQ Public Affairs, (301) 427-1364: Farah Englert, (301) 427-1865 (FEnglert@ahrq.gov).