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Dementia Often Missed When Primary Care Clinicians Rely on Symptoms

About a quarter of elderly patients without signs of cognitive impairment fail invited cognitive screens in primary care settings, according to a study in the Journal of the American Geriatrics Society. U.S. Preventive Services Task Force guidelines say there is insufficient information to make a recommendation on such screening.

Veterans Affairs researchers offered screening to some 8000 veterans aged 70 and older without signs of cognitive impairment. About one quarter failed the 3-minute screening with Mini-Cog during the course of a routine primary care visit. In that group, those who agreed to further screening had impairment confirmed over 90% of the time.

The authors note that their approach identified cognitive impairment in roughly 10% of patients, versus 4% with traditional clinical discovery based on patients' symptoms.

The authors say that screening should be considered for all older adults, despite the lack of effective treatment. Such early warnings, they say, could avoid problems with driving, financial mismanagement, and social isolation.

LINK(S):

Journal of the American Geriatrics Society article (Free abstract)

USPSTF guidelines (Free)

Mini-Cog test (Free)

Published in Physician's First Watch February 14, 2012

Reader Remarks:

Review and add to remarks on this article

• impaired cognition in older adults
  ca evans, 14 Feb 2012 12:14 PM EST
  Specialty: Palliative Medicine
  when I was in private practice, screening for dementia was NOT productive, as all it seemed to do was alienate... [more]
• Impaired cognition in older adults
  C. Poplin, 21 Feb 2012 1:01 PM EST
  Specialty: Internal Medicine
  As a general internist, I also think screening for dementia is problematic, unless and until we have treatments. Perhaps it... [more]