USPSTF 'insufficient evidence' stance repeats 2014 recommendation
Six years ago, the U.S. Preventive Services Task Force (USPSTF) decided that there was insufficient evidence to say how the possible harms and benefits of screening older adults for cognitive impairment balanced out.
Today, despite a review that of 287 studies that included about 280,000 adults, the USPSTF announced that arrived at the same “insufficient evidence” conclusion.
“For the current recommendation, the USPSTF again concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults,” says the USPSTF recommendation, which was published in today’sJAMA.
But an accompanying editorial by Ronald C. Petersen and Kristine Yaffe argues for screening. Petersen, who has conducted landmark research into mild cognitive impairment (MCI), and Yaffe noted the Medical annual wellness visit has included payment for cognitive screening since 2011. They pointed to evidence that 10% of cognitive impairment may be caused by reversible problems like depression, adverse effects from medications, and metabolic disorders. Cognitive impairment screening could lead to earlier detection and resolution of these problems. They also say that information about a patient’s cognitive status could help physicians manage other conditions, such as diabetes.,
The evidence report for the USPSTF recommendation cited the IU CHOICE study as the one randomized clinical trial that investigated the direct effect of screening on patient outcomes. Results of the study, which compared roughly 2,000 screened adults to 2,000 unscreened adults, argue for a thumbs-down on screening. They showed no difference between the two groups according to several measures, including health-related quality of life, health care utilization, advanced care planning, and, surprisingly, dementia recognition.
The unimpressive results for the interventions for mild and moderate dementia and MCI are also discussed in the evidence report. The acetylcholinesterase inhibitors (donepezil [Aricept], galantamine [Razadyne], rivastigmine [Exelon] and memantine [Namenda] may help with cognitive functioning in the short term but the size of the change is small, says the evidence report.
The evidence for the effectiveness nononpharmacological interventions is similarly ho-hum, the evidence report concludes. A review of results from 61 randomized controlled trials showed no clear benefit on global or domain-specific measures of cognitive function, the report says.