Boustani M, Peterson B, Hanson L, Harris R, Lohr K. Screening for dementia in primary care: A summary of the evidence
for the U.S. Preventive Services Task Force. Ann Intern Med 2003;138(11):927-37.
Background: Dementia is a large and growing problem but is often not diagnosed in its earlier stages. Screening and
earlier treatment could reduce the burden of suffering of this syndrome.
Purpose: To review the evidence of benefits and harms of screening for and earlier treatment of dementia.
Data Sources: MEDLINE, PsycINFO, EMBASE, the Cochrane Library, experts, and bibliographies of reviews.
Study Selection: The authors developed eight key questions representing a logical chain between screening and improved
health outcomes, along with eligibility criteria for admissible evidence for each question. Admissible evidence was obtained
by searching the data sources.
Data Extraction: Two reviewers abstracted relevant information using standardized abstraction forms and graded article
quality according to U.S. Preventive Services Task Force criteria.
Data Synthesis: No randomized, controlled trial of screening for dementia has been completed. Brief screening tools can
detect some persons with early dementia (positive predictive value 50%). Six to 12 months of treatment with cholinesterase
inhibitors modestly slows the decline of cognitive and global clinical change scores in some patients with mild to moderate
Alzheimer disease. Function is minimally affected, and fewer than 20% of patients stop taking cholinesterase inhibitors
because of side effects. Only limited evidence indicates that any other pharmacologic or nonpharmacologic intervention slows
decline in persons with early dementia. Although intensive multicomponent caregiver interventions may delay nursing home
placement of patients who have caregivers, the relevance of this finding for persons who do not yet have caregivers is
uncertain. Other potential benefits and harms of screening have not been studied.
Conclusions: Screening tests can detect undiagnosed dementia. In persons with mild to moderate clinically detected
Alzheimer disease, cholinesterase inhibitors are somewhat effective in slowing cognitive decline. The effect of cholinesterase
inhibitors or other treatments on persons with dementia detected by screening is uncertain.
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