Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force

Article Abstract:

Background: Dementia is a large and growing problem but is often not diagnosed in its earlier stages. Screening and earlier treatment could reduce the burden of suffering of this syndrome. Purpose: To review the evidence of benefits and harms of screening for and earlier treatment of dementia. Data Sources: MEDLINE, PsycINFO, EMBASE, the Cochrane Library, experts, and bibliographies of reviews. Study Selection: The authors developed eight key questions representing a logical chain between screening and improved health outcomes, along with eligibility criteria for admissible evidence for each question. Admissible evidence was obtained by searching the data sources. Data Extraction: Two reviewers abstracted relevant information using standardized abstraction forms and graded article quality according to U.S. Preventive Services Task Force criteria. Data Synthesis: No randomized, controlled trial of screening for dementia has been completed. Brief screening tools can detect some persons with early dementia (positive predictive value <=50%). Six to 12 months of treatment with cholinesterase inhibitors modestly slows the decline of cognitive and global clinical change scores in some patients with mild to moderate Alzheimer disease. Function is minimally affected, and fewer than 20% of patients stop taking cholinesterase inhibitors because of side effects. Only limited evidence indicates that any other pharmacologic or nonpharmacologic intervention slows decline in persons with early dementia. Although intensive multicomponent caregiver interventions may delay nursing home placement of patients who have caregivers, the relevance of this finding for persons who do not yet have caregivers is uncertain. Other potential benefits and harms of screening have not been studied. Conclusions: Screening tests can detect undiagnosed dementia. In persons with mild to moderate clinically detected Alzheimer disease, cholinesterase inhibitors are somewhat effective in slowing cognitive decline. The effect of cholinesterase inhibitors or other treatments on persons with dementia detected by screening is uncertain.

---

Screening for dementia: recommendation and rationale

Article Abstract:

This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for dementia and the supporting scientific evidence and updates the 1996 recommendations on this topic. The complete USPSTF recommendation and rationale statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (www.preventiveservices.ahrq.gov) and the National Guideline Clearinghouse (www.guideline.gov) and in print by subscribing to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates. The cost of this subscription is $60, and it can be ordered through the Agency for Healthcare Research and Quality (AHRQ) Publications Clearinghouse (call 1-800-358-9295 or e-mail ahrqpubs@ahrq.gov). The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned. The summary of the evidence is also available in print through the AHRQ Publications Clearinghouse.

---

Clinical strategies for breast cancer screening: weighing and using the evidence

Article Abstract:

Doctors may need to discuss with their patients the benefits of breast cancer screening versus the harms and costs to determine whether the patient should be screened. An analysis of randomized controlled trials on the subject shows that breast cancer screening may decrease mortality from breast cancer by 15% to 30% among women aged 50 to 69 years, or by two to four women per 1000. The benefit of screening for women aged 40 to 49 may be less clear, and the harm of screening, false-positive results and subsequent unnecessary treatment, and increased anxiety, may outweigh the potential benefit of screening for the younger group. Doctors should talk to their patients to find out how they perceive their risk of breast cancer and the benefit to them of screening.

Breast cancer

Similar abstracts:

• Abstracts: Length of stay in home care before and after the 1997 Balanced Budget Act. Hospice use among Medicare managed care and fee-for-service patients dying with cancer
• Abstracts: Protective effects of C5a blockade in sepsis. Novel strategies for the treatment of sepsis
• Abstracts: Learning from past complaints to improve the care of patients. Are nurse picking up doctors' unwanted tasks?
• Abstracts: Trifolium pratense for breast disease: a case series. Diuretics most effective hypertension drug
• Abstracts: A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.