Year: 2019
Type: article
Study design: Systematic Review
Abstract: Purpose: To review the evidence concerning screening for dementia syndrome (hereafter, dementia) in primary care settings to support recommendations from the US Preventive Services Task Force (USPSTF). Data Sources: We searched MEDLINE, PsychiNFO, EMBASE, and the Cochrane Collaboration Library from January 1994 to November 2001, with all searches limited to English language studies. Study Selection: We developed an analytic framework and key questions concerning dementia screening and treatment to guide our search. We developed inclusion and exclusion criteria for each key question. For questions of prevalence or accuracy of screening tests, we required cross-sectional or cohort studies in a primary care population with an acceptable reference standard for diagnosis. For questions of treatment, we included randomized controlled trials (RCTs) of subjects with mild to moderate dementia. Data Extraction: Two reviewers agreed on studies meeting inclusion and exclusion criteria and graded them according to USPSTF criteria. They then extracted data from included studies of fair to good quality and entered the data into evidence tables. Data Synthesis: The prevalence of dementia increases with age and affects 25% to 47% of people age 85 years and older. More than one-half of patients with dementia in primary care practices are undiagnosed. We found no RCT of screening for dementia. The Mini-Mental Status Examination (MMSE) is a brief screening tool with clinically acceptable reliability and accuracy. Although no effective treatment has yet been documented for early vascular dementia, cholinesterase inhibitors slow the rate of cognitive decline in people with mild to moderate Alzheimer's disease with mild adverse effects. Antidepressant medication is effective in reversing depressive symptoms in early dementia, but medical treatment of other behavioral and mood symptoms in early dementia is poorly studied. Intensive multi-component interventions for caregivers may delay nursing home placement and decrease caregiver burden, but they do not affect patients' health outcomes. Other benefits of screening and the potential harm of labeling have not been studied. Conclusion: Screening tests can detect undiagnosed dementia and cholinesterase inhibitors effectively slow the rate of cognitive decline in people with mild to moderate Alzheimer's disease. The effect of these drugs or other treatments on people with dementia detected by screening is uncertain.
DOI: 10.17615/0mhc-7p11
Author: Boustani, Malaz
Institution: University of North Carolina at Chapel Hill
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2953485736