Should older adults be screened for dementia? It is important to screen for evidence of dementia!

Multiple arguments for considering routine dementia screening have been presented. Furthermore, dementia diagnoses are widely unrecognized. As a result, persons with dementia are missing important clinical care and treatment interventions. By distinction, the problems of defining, diagnosing, and treating mild cognitive impairment (MCI) are not yet resolved, and MCI is not ready for a screening recommendation. Dementia screening approaches, including cognitive testing and functional assessment, must be evaluated on their scientific merits, including sensitivity and specificity for recognizing affected individuals in at‐risk populations. Screening tests must be “cost‐worthy”, with the benefits of true‐positive test results justifying the costs of testing and resolving false‐positive cases, with due consideration for proper diagnostic evaluation and potential harms. With the tremendous number of new cases projected in the near future and the expected emergence of beneficial therapies, considerably more research is needed to develop more efficient screening systems.

[1]  M. Sano,et al.  Realistic expectations for treatment success in Alzheimer's disease. , 2006, The journal of nutrition, health & aging.

[2]  Soo Borson,et al.  Should older adults be screened for dementia? , 2006, Alzheimer's & Dementia.

[3]  Vijaya L. Melnick,et al.  Alzheimer’s Dementia , 1985, Contemporary Issues in Biomedicine, Ethics, and Society.

[4]  G. Guyatt,et al.  Users' guides to the medical literature. , 1993, JAMA.

[5]  J. Raftery,et al.  Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial , 2004, The Lancet.

[6]  L. Jarvik,et al.  Physostigmine and its effect on six patients with dementia. , 1981, The American journal of psychiatry.

[7]  C. Wolfson,et al.  Undetected Dementia in Community‐Dwelling Older People: The Canadian Study of Health and Aging , 2000, Journal of the American Geriatrics Society.

[8]  H. Kraemer,et al.  Donepezil treatment and Alzheimer disease: can the results of randomized clinical trials be applied to Alzheimer disease patients in clinical practice? , 2007, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[9]  S. Azen,et al.  Detecting cognitive impairment in primary care: performance assessment of three screening instruments. , 2007, Journal of Alzheimer's disease : JAD.

[10]  Neil B. Minkoff,et al.  Recommendations for best practices in the treatment of Alzheimer's disease in managed care. , 2006, The American journal of geriatric pharmacotherapy.

[11]  P. Solomon,et al.  Should we screen for Alzheimer's disease? A review of the evidence for and against screening Alzheimer's disease in primary care practice. , 2005, Geriatrics.

[12]  F. Schmitt A BRIEF ALZHEIMER'S SCREEN FOR CLINICAL PRACTICE , 2006 .

[13]  S. Finkel Cognitive screening in the primary care setting. The role of physicians at the first point of entry. , 2003, Geriatrics.

[14]  Lee Bowman,et al.  Impact of cognitive impairment on mild dementia patients and mild cognitive impairment patients and their informants , 2006, International Psychogeriatrics.

[15]  W M Tierney,et al.  Documentation and Evaluation of Cognitive Impairment in Elderly Primary Care Patients , 1995, Annals of Internal Medicine.

[16]  V. Valcour,et al.  The detection of dementia in the primary care setting. , 2000, Archives of internal medicine.

[17]  W. Dale,et al.  High Interest in Screening and Treatment for Mild Cognitive Impairment in Older Adults: A Pilot Study , 2006, Journal of the American Geriatrics Society.

[18]  R. Abbott,et al.  Frequency and characteristics of silent dementia among elderly Japanese-American men. The Honolulu-Asia Aging Study. , 1997, JAMA.

[19]  J. Wesson Ashford,et al.  ApoE genotype accounts for the vast majority of AD risk and AD pathology , 2004, Neurobiology of Aging.

[20]  D. Libon,et al.  Dementia Screening Tools for the Primary Care Physician , 2007 .

[21]  Malcolm Man-Son-Hing,et al.  Clinical Utility of Office‐Based Cognitive Predictors of Fitness to Drive in Persons with Dementia: A Systematic Review , 2006, Journal of the American Geriatrics Society.

[22]  Paul R. Solomon,et al.  Should we screen for Alzheimer's disease? , 2005 .

[23]  B. Freund Office‐Based Evaluation of the Older Driver , 2006, Journal of the American Geriatrics Society.

[24]  R. Petersen Mild cognitive impairment as a diagnostic entity , 2004, Journal of internal medicine.

[25]  G H Guyatt,et al.  Users' guides to the medical literature: XVII. How to use guidelines and recommendations about screening. Evidence-Based Medicine Working Group. , 1999, JAMA.

[26]  D. Knopman,et al.  Patterns of Care in the Early Stages of Alzheimer's Disease: Impediments to Timely Diagnosis , 2000, Journal of the American Geriatrics Society.