Screening for Cognitive Impairment in Older Adults

The US Preventive Services Task Force (USPSTF) recently published recommendations on screening for cognitive impairments in older adults.

Cognitive impairment refers to problems with learning and memory, language, executive function (managing daily work and life), attention, perceptual motor skills (interacting with the environment), and social cognition (interacting with other people). There is a wide spectrum of cognitive impairment in adults that ranges from mild (barely noticeable) to full-blown dementia (most commonly Alzheimer disease).

Risk factors for cognitive impairment include older age, heart disease or risk factors for heart disease (such as diabetes, high blood pressure, high cholesterol, and obesity), certain genetic mutations (including those linked with Alzheimer disease), depression, and physical frailty.

With milder forms of cognitive impairment, changes are often not noticed by patients or their friends or family. Therefore, screening tests for cognitive impairment are of interest to primary care clinicians.

Many brief screening tests for cognitive impairment are available. Commonly used tests include the Mini-Mental State Examination as well as the clock-drawing test. Screening tests generally involve asking patients to perform a series of tasks that assess 1 or more aspects of cognitive function. A positive screening test result leads to additional testing for dementia that can include blood tests, magnetic resonance imaging of the brain, and more in-depth neuropsychologic testing by specialists.

This recommendation applies to adults aged 65 years or older who live in the community (ie, not in a nursing home) who do not have any signs or symptoms of cognitive impairment.

Early detection of cognitive impairment may allow for earlier treatment of reversible causes (such as a thyroid problem or a vitamin deficiency). It might also help doctors prepare for problems patients may have in understanding medical treatment plans and provide both doctors and patients better opportunities for advanced care planning. However, the USPSTF found no studies that looked at the direct effect of screening for cognitive impairment on outcomes related to cognitive function. The USPSTF also did not find adequate evidence that screening for cognitive impairment improves decision-making or planning by patients, caregivers, or doctors. There is also little evidence on potential harms. One potential harm is that labeling a person with a progressive illness (for which there is little treatment) may cause stress, depression, and lower quality of life. There are also side effects to some medications used to treat cognitive impairment.

The USPSTF concludes that there is not enough evidence to weigh the balance of benefits and harms of screening for cognitive impairment.

Financial Disclosures: None reported.

Source: US Preventive Services Task Force. Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement [published February 25, 2020]. JAMA. doi:10.1001/jama.2020.0435