USPSTF: Evidence lacking for cognitive impairment testing

24 oct 2013—Screening instruments can detect dementia but there is insufficient evidence to determine the clinical effect of screening and interventions, according to a review conducted for the U.S. Preventive Services Task Force and published online Oct. 22 in the Annals of Internal Medicine.

Jennifer S. Lin, M.D., from Kaiser Permanente Northwest in Portland, Ore., and colleagues conducted a systematic literature review to examine the diagnostic accuracy of cognitive screening instruments and the benefits and harms of interventions for early cognitive impairment.

Based on the findings, the researchers note that the most thoroughly studied instrument was the Mini-Mental State Examination, which is not available without cost. Publicly available instruments that have adequate performance for detecting dementia include the Clock Drawing Test, the Mini-Cog, the Memory Impairment Screen, and the Short Portable Mental Status Questionnaire. Limited benefit, with unclear clinical relevance, was seen with use of U.S. Food and Drug Administration-approved medications and caregiver interventions. Benefits were also limited by common adverse events and restricted availability of caregiver interventions. Limited evidence was available to support cognitive stimulation and exercise for persons with mild-to-moderate dementia or mild cognitive impairment.

"Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear," the authors write.

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