• USPSTF Final Recommendation

    Evidence Lacking on Cognitive Impairment Screening in Older Adults

    February 26, 2020 03:26 pm News Staff -- Many people experience cognitive impairment as they age, with most instances occurring in those older than 65. The condition may range from mild impairment, in which people are still able to function independently, to dementia, which hinders their ability to function independently in daily life.

    On Feb. 25, the U.S. Preventive Services Task Force posted a final recommendation statement and final evidence summary on screening for cognitive impairment in older adults. The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening in this population. This is an "I" recommendation.

    "Cognitive impairment is an important public health concern that has a significant impact on the lives of older Americans and their families," remarked Chyke Doubeni, M.D., M.P.H., a member of the task force, in a press release. "Currently, there is not enough evidence for the task force to recommend for or against screening for cognitive impairment in older adults who do not have signs or symptoms."

    What's needed, according to USPSTF Chair Douglas Owens, M.D., M.S., is "more research to address this serious issue."

    older man and woman

    "Research is especially needed on whether screening and early detection of cognitive impairment helps patients, caregivers and doctors make decisions about health care or plan for the future."

    Update of Previous Recommendation

    The final recommendation statement mirror's the task force's 2014 recommendation, in which the USPSTF also concluded that the evidence was insufficient to balance the benefits and harms of such screening. The AAFP supported that position at the time.

    To update the previous recommendation, the task force commissioned a systematic review on the benefits and harms of screening. The task force included both MCI and dementia under the broader term "cognitive impairment" in its review.

    The review examined the direct evidence on the benefits and harms of screening community-dwelling adults, including those 65 and older who reside in independent living facilities, for cognitive impairment versus no screening, the accuracy of screening instruments to detect MCI and dementia, and the benefits and harms of treatment for MCI and moderate to mild dementia. The review focused on older adults, because the task force considered these patients most likely to be identified through screening.

    The USPSTF concluded that overall, evidence on the potential benefits of screening for cognitive impairment is limited by several factors, including the short duration of most trials, the heterogenous nature of interventions and inconsistencies in outcomes reported. Although studies of some interventions reported improvements in various measures of cognitive function, the average effect sizes were small and of uncertain clinical importance.

    In addition, none of the interventions specifically targeted screen-detected populations. Because most of the current evidence suggests that improvement applies to people with moderate dementia, its applicability to a screen-detected population is uncertain.

    Story Highlights

    Response to Public Comment

    The USPSTF posted a draft recommendation statement and draft evidence review for public comment on the organization's website from Sept. 10 to Oct. 7, 2019.

    Several commenters expressed concern that readers could misinterpret the I statement as a recommendation against screening. In response, the USPSTF clarified that the I statement is a conclusion that the evidence is insufficient to balance the benefits and harms of screening and is neither a recommendation for nor against screening.

    A number of commenters disagreed with the I statement and thought the USPSTF should recommend screening based on the potential benefits arising from early detection and treatment of cognitive impairment. The USPSTF responded by stating that while there may be important reasons to identify cognitive impairment early, none of the potential benefits have been clearly demonstrated in controlled trials.

    After some commenters suggested that cognitive impairment often goes unrecognized, the USPSTF added language to the Practice Considerations section of the statement noting that clinicians should remain alert for early signs or symptoms of impairment.

    The USPSTF also added the American Academy of Neurology's guidelines on the detection of cognitive impairment to the statement's Recommendations of Others section.

    Up Next

    The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence summary and will then determine the Academy's stance on the recommendation.