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March 12, 2008

Primary Care Screening for Dementia and Mild Cognitive Impairment—Reply

JAMA. 2008;299(10):1132-1134. doi:10.1001/jama.299.10.1133

In Reply: In our Commentary, we concluded that at present there is insufficient evidence for the systematic introduction of dementia screening in primary care and recommended that the scientific community design and conduct a randomized controlled trial that would compare dementia screening to case-finding enhancement in regard to reducing the overall societal burden of dementia.

Drs Rafii and Galasko introduce the topic of MCI. Mild cognitive impairment is a disputed and evolving concept with variable sets of criteria and prognostic significance in population studies.1 The first requirement for screening is to have a clearly defined entity, and at present MCI does not meet this criterion. In certain research settings, some of the criteria have been demonstrated to be useful, but the evidence is not sufficient for primary care.1,2 Rafii and Galasko also suggest a parallel with diabetes. There is not a systematic screening program for prediabetes, and in the United Kingdom, diabetes screening itself is not currently recommended.3 Only those persons at high risk are screened, and there are large studies ongoing to establish the value of more general diabetes screening.