Putting Prevention into Practice
An Evidence-Based Approach
Screening for Cognitive Impairment in Older Adults
Am Fam Physician. 2020 Jun 15;101(12):753-754.
Author disclosure: No relevant financial affiliations.
L.C. is a 70-year-old Asian American woman who retired from teaching middle school five years ago. She lives independently and has a daughter and grandchildren who live within 30 miles of her. She presents for a follow-up visit to renew her hypertension medications. Her blood pressure is well controlled by an angiotensin receptor blocker, and she takes no other medications. She does not smoke, and she drinks two or three glasses of wine per week. She states that she is trying to stay active but is finding it difficult to make new friends and learn new skills. She is worried about her memory and wants to know whether she should be screened for cognitive impairment.
Case Study Questions
1. Based on the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for cognitive impairment, what would you recommend for L.C.?
A. L.C. should be screened because the USPSTF found convincing evidence that the net benefit of screening in adults 65 years and older is substantial.
B. L.C. should be screened because she has hypertension.
C. L.C. should not be screened because the USPSTF recommends screening only in older adults who are current smokers.
D. It is uncertain whether L.C. should be screened. The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for cognitive impairment in older adults.
E. L.C. should not be screened because the USPSTF found adequate evidence that screening for cognitive impairment is of no net benefit.
2. According to the USPSTF recommendation statement, which of the following statements about screening tests for cognitive impairment are correct?
A. Some screening tools have relatively high sensitivity and specificity for the detection of dementia.
B. Screening tools have a positive predictive value approaching 80% for people who are in their 60s.
C. Screening tools generally have lower sensitivity and specificity for the detection of mild cognitive impairment than for the detection of dementia.
1. U.S. Preventive Services Task Force. Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. JAMA. 2020;323(8):757–763.
2. Patnode CD, Perdue LA, Rossom RC, et al. Screening for cognitive impairment in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2020;323(8):764–785.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cognitive-impairment-in-older-adults-screening#fullrecommendationstart.
This series is coordinated by Kenny Lin, MD, MPH, deputy editor.
A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.
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