February 17th, 2012

Podcast 146: Cognitive impairment in primary care — screen or not?

Current guidelines find no compelling therapeutic benefit to screening for cognitive impairment and dementia in primary care. The Journal of the American Geriatrics Society has published some research that, if not compelling, certainly suggests that clinical approaches should change.

In actively screening some 8000 veterans over age 70 during routine primary care visits for cognitive impairment, researchers found a quarter to have signs suggesting further investigation was needed. When all was said and done, 11% had cognitive impairment; that’s two to three times the rate found in settings where physicians waited for impairment to manifest itself clinically.

We interview the lead author, who offers reasons why he thinks simple screening should be routine in elderly populations, despite the current absence of treatments for mild cognitive impairment and dementia.


Physician’s First Watch coverage (free)

Journal of the American Geriatrics Society abstract (free)

USPSTF current screening guidelines (free)

Mini-Cog screening test (free)

2 Responses to “Podcast 146: Cognitive impairment in primary care — screen or not?”

  1. Daniele Michaud says:

    Forgive my cynicism, but in real-life practice, what I see resulting from all that screening is huge numbers of extremely anxious patients and families insisting on medication to “do something to prevent dementia,” and pharmaceutical companies laughing all the way to the bank.

  2. Neil Hall, MD says:

    While the intent of such screening is admirable, making a recommendation for all primary care based on opinion is not. This is another example of our medical establishment’s tendency to do something before we know whether or not it improves outcomes. As we have learned repeatedly (think of chest X-ray screening for lung cancer, blood markers to screen for ovarian cancer, and now PSA for prostate cancer), screening frequently gives no better, or even worse results than not screening. And it always costs more!

    It would be wonderful if screening truly results in better quality of life and medical care of patients with dementia. But what if it doesn’t, and we have mainly created a group of worried and depressed people who used to think they were normal. The harms of screening can be real. We must first find out whether the benefits are worth it before we jump on an expensive bandwagon that may worsen the quality of life rather then improve it.

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