January 21, 2020
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Dementia screening safe but offers few benefits by itself

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Nicole Fowler

Screening for Alzheimer’s disease and related dementias in primary care settings did not result in any harm as measured by patient-reported anxiety and depressive symptoms, according to findings of a randomized controlled trial published in Journal of the American Geriatrics Society. However, the researchers did not find any benefit from screening in increasing advance care planning or reducing ED hospitalizations and visits.

“Despite some people’s concerns about how people might feel if they are screened for dementia, especially if they screen positive, this study found that screening did not induce depression or anxiety in older adults,” Nicole Fowler, PhD, MHSA, research scientist at the Regenstrief Institute and associate director of Indiana University Center for Aging Research at Regenstrief Institute, told Healio Psychiatry. “Many patients and families have concerns that dementia screenings may create anxiety or depression in patients because there is, as yet, no cure for this disease. However, this study shows that is not the case.”

To determine whether the benefits outweigh the harms of screening for Alzheimer’s disease and related dementias, Fowler and colleagues randomly assigned 4,005 primary care patients aged 65 years or older to either receive screening (n = 2,008) or to serve as controls and receive no screening (n = 1,997). They screened patients using the Memory Impairment Screen or the Mini-Cog, and referred them for a voluntary follow-up diagnostic assessment if either or both tests produced positive results. As primary measures, they used health-related quality of life at 12 months, depressive symptoms according to the Patient Health Questionnaire-9 and anxiety symptoms at 1 month according to the Generalized Anxiety Disorder seven-item scale.

The researchers reported that they were unable to detect differences in health-related quality of life between the groups at 12 months. Differences in mean depressive symptoms and anxiety symptoms at 1 month fell within prespecified equivalency range, they noted. At all time points, depressive and anxiety symptoms scores were similar between the groups. At 12 months, they detected no differences in health care utilization, advance care planning and Alzheimer’s disease and related dementias recognition by physicians. Of participants who screened positive for cognitive impairment, 70% declined a follow-up diagnostic assessment. Those who completed a follow up and then received collaborative care had significantly decreased rates of hospital admissions compared with those who were not screened but who later developed cognitive impairment.

Early detection of dementia through screening in primary care is possible, though accessible diagnostic follow-up options, and care if diagnosed, need to accompany screening processes,” Fowler said. “Screening alone is unlikely beneficial.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.