No Benefit to Community-Wide Dementia Screening: Review
But worrisome symptoms could merit a visit to the doctor, experts say
Wednesday, July 17, 2013
"We found no evidence that population screening would lead to better clinical or psychosocial outcomes, no evidence furthering our understanding of the risks it entails and no indication of its added value compared to current practice," said study author Carol Brayne, a professor of public health medicine from Cambridge Institute of Public Health, in the United Kingdom. She and her colleagues were to present their findings Wednesday at the annual Alzheimer's Association International Conference, in Boston.
For years, there has been wide debate among health advocacy groups and policymakers over whether or not community-wide screening for dementia helps patients and saves health care dollars. Because there is no cure for Alzheimer's, many argue against the need for it, but as many as 50 percent of people with dementia go undiagnosed, the authors said.
Given the debate, Brayne said she was surprised by "the extent of the lack of evidence that supports it [community-wide screening]."
For the study, she and colleagues reviewed all of the available studies on the issue. "We wanted to try to find all the relevant studies and then assess how well they addressed the specific question we were asking about screening in populations," said Brayne.
"Out of all of them, there were only six presenting some information about cost and economic implications; we found none with regards to clinical and psychosocial outcomes, such as cognitive, emotional health, social and planning benefits of population screening," Brayne said.
The team added that significant resources are required to screen for dementia, and there is no indication that it adds value compared to current screening practices.
Dr. Murali Doraiswamy, a professor of psychiatry and medicine at Duke University Medical Center and the author of The Alzheimer's Action Plan, said, "I think this study is empowering information in some sense. The general policy is we don't want to do screening unless two criteria are met: the screening test has to have a high degree of accuracy; and two, the results of the screening end up with some kind of an intervention that improves the outcome for a person."
For the vast number of screening tests, the value is overstressed, said Doraiswamy. "We're starting to learn as a country the massive harm people suffer as a result of promoting screening tests -- from raising anxiety of patients to doing unnecessary procedures that result in incidental findings," he added.
The study results don't suggest ignoring troubling symptoms, though.
Family and friends worried about a loved one should check in with their doctor, said Dr. Heather Snyder, director of medical and scientific operations at the Alzheimer's Association. People who have a parent or sibling with Alzheimer's are at a higher risk, too, she said.
"If you are concerned about yourself or your loved one's ability to remember things, know the warnings signs of Alzheimer's, speak to your health care provider, or go to www.alz.org if you need help getting connected with a local physician," said Snyder.
She also pointed out that sometimes other health issues -- such as hormone imbalances, multiple medication use and nutrition deficiencies -- can cause memory problems, and they are treatable. "That's why it is important to speak to a health care provider if you have questions about memory changes," said Snyder.
Brayne said future research might focus on higher-risk groups. "A research program that tested systematic screening in populations that are known to be at higher risk could be part of a clearer strategy to generate the evidence we need to make informed decisions as a whole society," she noted.
Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.