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USPSTF 2020 does not recommend for or against screening for cognitive impairment in older adults (I recommendation)
Question clinique
Should primary care clinicians screen for cognitive impairment in community-dwelling adults 65 years or older?
L’Essentiel
In this updated 2020 review, the US Preventive Services Task Force (USPSTF) found insufficient evidence to assess the balance of benefits and harms of screening for cognitive impairment in community-dwelling adults 65 years or older, including those residing in independent living facilities (I recommendation). This recommendation only applies to older adults without recognized signs or symptoms of cognitive impairment. These recommendations are consistent with the 2014 USPSTF recommendation statement. 2c
Référence
Plan de l'etude: Practice guideline
Financement: Government
Cadre: Population-based
Sommaire
In this updated review, the task force found one randomized clinical trial (n = 4005) that directly assessed the effect of screening for cognitive impairment on patient-oriented outcomes. No significant differences occurred in health-related quality of life at 6 months or 12 months, health care use, or measures of advance-care planning in the screening groups versus the control groups. Adequate evidence is available that some screening tools have high sensitivity and specificity for the detection of dementia. However, the task force evaluated the effects of various pharmacologic and nonpharmacologic treatment regimens and found only minimal changes that were not considered clinically important. In addition, interventions to support caregivers also have a small effect — the clinical importance of which remains uncertain. No direct evidence of harm from screening was found. The American Academy of Family Physicians supports the 2014 USPSTF recommendation, which is similar to this update. The American Academy of Neurology currently recommends assessing for cognitive impairment.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Commentaires
Don't screen for cognitive impairment in primary care
An RCT shows screening does not work. And treatment offers "only minimal changes that were not considered clinically important." This should have been a 'D' recommendation: 'Don't' do it.