Insufficient evidence for dementia screening tests in older adults

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1. This USPSTF review concludes that the available evidence is insufficient to assess the benefits and harms of screening for cognitive deficits in adults over the age of 65.

2. The mini-mental state examination, the screening test with the most evidentiary support, has a pooled sensitivity of 88.3% and a pooled specificity of 86.2%

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Dementia affects millions of Americans and the cumulative care costs associated with this disease totaled approximately $183 billion in 2011. In this update to a 2003 recommendation statement, the U.S. Preventive Services Task Force (USPSTF) reviewed the evidence associated with screening tests used to detect either dementia or mild cognitive impairment (MCI). The review led the USPSTF to conclude that the currently available evidence regarding the benefits and harms of screening for cognitive deficits in older adults was not sufficient. However, the literature review did find enough evidence to support the mini-mental state examination (MMSE) as a reliable screening test. The USPSTF found 25 studies examining the MMSE, and 14 of these were used to compute pooled sensitivity and specificity figures of 88.3% and 86.2%, respectively. The literature review produced insufficient evidence to comment on the harms of most screening/preventive measures, with the notable exception of acetylcholinesterase inhibitors (AChEIs). The pooled results of 54 studies showed that this pharmacological intervention slightly improves global cognitive function, but it is also associated with several adverse effects, including bradycardia and CNS disturbances. It is clear that more studies examining the harms of screening tests are needed. More studies focusing on the screening and treatment of MCI are also needed, since the current body of evidence favors the analysis of tests for dementia over MCI.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Improving dementia care: The role of screening and detection of cognitive impairment

In-Depth [systematic review]: The USPSTF reviewed evidence on the benefits, harms and performance of screening tests used to detect dementia or MCI in older adults. The review also examined studies on the benefits and harms of treatment and management options used in patients diagnosed with early dementia or MCI. The target patient population was limited to adults in the general primary care population and those who were identified as cognitively impaired as a result of a positive screening test. The MMSE was the screening test with the highest amount of evidence in the literature, and this was used to compute a pooled sensitivity of 88.3% (95%CI 81.3%-92.9%) and a pooled specificity of 86.2% (95%CI 81.8%-89.7%) for this test. All other tests and treatments had insufficient evidence to suggest that they provided any benefits or harms in the detection/management of dementia and MCI.

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