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Dementia Often Missed When Primary Care Clinicians Rely on Symptoms — Physician’s First Watch

Medical News |
February 14, 2012

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.

Reader Comments (3)

Sasha Other Healthcare Professional, Other

I think that many physicians (such as those who listed above comments) fail to consider the benefits of diagnosing dementia sooner rather than later. While there may not be treatment that is effective, a diagnosis can alert other professionals, such as social workers, to begin the discussions of long term care planning,
Advance Directives, and financial power of attorneys.

C. Poplin

As a general internist, I also think screening for dementia is problematic, unless and until we have treatments. Perhaps it could help a patient with a good support system and a family, plan, but how about a single adult with no support system, or someone who is still working? And of course, a diagnosis of dementia makes a patient instantly uninsurable, particularly for long-term care.

Competing interests: None declared

ca evans

when I was in private practice, screening for dementia was NOT productive, as all it seemed to do was alienate those who had it, and then irritate their families, as there was NOTHING that could help to any significant effect.

Competing interests: None declared

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