Should All Older Adults Be Screened for Dementia?

Doctor with elderly patientShould older adults be routinely screened for Alzheimer’s disease or memory problems? Maybe, maybe not. A government panel says there’s not yet enough data to recommend either for or against it. The panel’s uncertainty reflects the complexity of the issue at a time when scientists are progressing much faster in their ability to diagnose Alzheimer’s than in their ability to treat it.

This news is especially relevant in light of the recent discovery of a blood test that can predict with 90 percent accuracy who will get mild cognitive impairment or Alzheimer’s within two to three years.  Mild cognitive impairment is a less severe form of memory loss than dementia. It sometimes, but not always, progresses to Alzheimer’s disease.

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Just last week, Maria Carrillo, vice president of medical and scientific relations for the Alzheimer’s Association, told NPR that identifying people at high risk for Alzheimer’s could help scientists find treatments that can stop the disease before it takes hold. Currently, more than 5 million Americans have the disease, according to the Alzheimer’s Association, and a new study found that the condition may cause up to six times more deaths than previously reported.

So wouldn’t it make sense to find out who will get Alzheimer’s?

Not so fast, says Douglas Owens, M.D., professor of medicine at Stanford University and a member of the task force that published the recommendations in the Annals of Internal Medicine. Screening every older person for dementia or mild cognitive impairment isn’t worthwhile because there are presently no treatments that work to slow the progression of Alzheimer’s disease or reverse memory problems. The panel noted that the best argument for screening would be to give the patient and potential caregivers the opportunity to plan for the future, but the panel didn’t find any studies showing that the ability to plan for Alzheimer’s disease or other memory problems was either helpful or harmful.

Owens, however, stresses that this recommendation applies only to people who aren’t worried about their memory. “If someone has concerns, or their family is concerned, they should see their doctor for an evaluation,” he says. Currently, screening tests involve doctors asking patients to perform tasks to evaluate memory, language and attention. It will be years before doctors can use the new blood test, and  biomarker tests to diagnose Alzheimer’s are far from conclusive.

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With the implementation of the Affordable Care Act, Medicare began covering the detection of cognitive impairment as a part of the annual wellness visit benefit in 2011. In 2013, the Alzheimer’s Association published guidelines to help primary care doctors assess cognitive impairment at the wellness visit.

Photo: sunabesyou/iStock

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