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February 28, 2020

Should older adults get cognitive screenings? It's complicated.

Daily Briefing

    The U.S. Preventive Services Task Force (USPSTF) in a recommendation statement published Tuesday in JAMA declined to endorse or oppose cognitive screening for older adults, shining new light on an ongoing discussion about the benefits and harms of the practice, Judith Graham reports for Kaiser Health News.

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    The screening debate

    Almost six million U.S. adults have Alzheimer's disease, and researchers expect that number will reach 14 million by 2050.

    However, providers don't regularly screen elderly adults, who are most susceptible to developing dementia and Alzheimer's, for the conditions, Graham reports. Graham notes that a 2018 survey conducted by the Alzheimer's Association found that 16% of seniors said their physicians regularly checked their cognition, even though 82% said they thought cognition screenings are important. Further, Graham reports that several studies suggest physicians overlook signs of cognitive decline in older adults "at least 50% of the time."

    In response, some health experts recommend that all seniors receive regular cognitive screening, which involves a series of short tests meant to highlight problems with a patient's cognition. Supporters of the practice argue that testing all seniors will help identify patients with previously unrecognized symptoms of cognitive decline, allowing the patients to plan for a future when the decline is more severe.

    "This can start a discussion with your doctor: 'You know, you're having problems with your cognition, let's follow this up,'" said Stephen Rao, a researcher with the Cleveland Clinic's Lou Ruvo Center for Brain Health.

    On the other hand, some health experts argue that there are no proven benefits associated with routine cognitive screening for all seniors and caution that universal screening could cause harm.

    Benjamin Bensadon, an associate professor of geriatric medicine at the University of Florida College of Medicine, said, "Getting a positive result can make someone wary about their cognition and memory for the rest of their life."

    USPSTF declines to endorse or oppose universal cognitive screenings

    USPSTF in its recommendation statement declined to take a side in the ongoing debate, noting the lack of scientific evidence on the benefits of universal cognitive screening for seniors.

    USPSTF said it found a lack of evidence that universal cognitive screening for seniors would improve patients' quality of life or help them get better care. For example, USPSTF examined a study published in December 2019 that involved 1,723 older adults who were screened for cognitive impairment and 1,693 who were not. USPSTF said the study did not provide evidence that seniors in the screening group had improved quality of life or lower rates of hospitalizations or ED visits a year after the screening was conducted when compared with seniors who were not screened. However, the study did find that seniors in the screening group were not more depressed than seniors who were not screened.

    USPSTF ultimately called for more research on universal cognitive screening for older adults to help inform future recommendations.

    Experts react

    Some experts said USPSTF's new statement shows universal screening will not improve outcomes for patients with cognitive decline on its own.

    "What seems clear is that screening in and of itself doesn't yield benefits unless it's accompanied by appropriate diagnostic follow-up and care," said Nicole Fowler, associate director of the Center for Aging Research at Indiana University's Regenstrief Institute and lead author of the study USPSTF examined.

    But experts also said USPSTF's decision shouldn't discourage providers from evaluating their patients' cognition.

    According to Ronald Petersen, director of the Mayo Clinic's Alzheimer's Disease Research Center, "There is increased awareness, both on the part of patients and physicians, of the importance of cognitive impairment." He said, "It would be a mistake if physicians didn't pay more attention to cognition and consider screening on a case-by-case basis."

    Similarly, Douglas Owens, USPSTF chair and a professor at Stanford University School of Medicine, said, "If someone has concerns … about their memory or cognitive abilities, they should certainly discuss that with their clinician" (Graham, Kaiser Health News, 2/25).

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