USPSTF: Insufficient evidence to screen asymptomatic older adults for cognitive impairment
The U.S. Preventive Services Task Force recently concluded that the evidence is insufficient to recommend screening for cognitive impairment in asymptomatic older adults.
The CDC has previously reported that the number of patients of Alzheimer’s disease and related dementias in the U.S. will nearly triple by 2060. Last year, the Alzheimer’s Association issued guidelines for early detection, accurate diagnosis, and appropriate management of neurodegenerative cognitive behavioral syndromes, AD and dementias in patients who are either symptomatic or asymptomatic.
USPSTF member Seth Landefeld, MD, told Healio Primary Care that, compared with the Alzheimer’s Association guidelines, which apply to both symptomatic and asymptomatic people, the USPSTF guidelines are “focused solely on preventive services for people who do not have any signs or symptoms of cognitive impairment.”
“While there is not currently enough evidence to make a recommendation about whether or not to screen for cognitive impairment in people who do not yet have any signs or symptoms, and no professional organizations recommend this type of screening, we encourage clinicians to remain alert for these issues and talk with patients and families about any concerns they have,” he continued.
The task force did not review evidence on how best to raise the issue of cognitive impairment with patients. Landefeld, who is also the chair of the department of medicine at the University of Alabama at Birmingham School of Medicine, said it is reasonable to ask patients and families about symptoms, but discussing such a serious illness can cause “depression, stress and an overall lower quality of life” for patients, especially because there is little they can do to change its course.
He said that clinicians who are concerned about a patient’s cognitive impairment based on personal observation “should be thoughtful and sensitive to these potential impacts as they use their clinical judgment to determine the best way to help the patient manage their health.”
The USPSTF’s draft statement and evidence review for screening older adults for cognitive impairment has been posted for public comment on the USPSTF website: www.uspreventiveservicestaskforce.org. Input will be accepted through Oct. 7, 2019 at www.uspreventiveservicestaskforce.org/tfcomment.htm.
– by Janel Miller
Disclosure: Landefeld reports no relevant financial disclosures.