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Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Patnode, Carrie D ; Perdue, Leslie A ; Rossom, Rebecca C ; Rushkin, Megan C ; Redmond, Nadia ; Thomas, Rachel G ; Lin, Jennifer S

JAMA : the journal of the American Medical Association, 2020-02, Vol.323 (8), p.764-785 [Periódico revisado por pares]

United States: American Medical Association

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  • Título:
    Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
  • Autor: Patnode, Carrie D ; Perdue, Leslie A ; Rossom, Rebecca C ; Rushkin, Megan C ; Redmond, Nadia ; Thomas, Rachel G ; Lin, Jennifer S
  • Assuntos: Adults ; Aged ; Alzheimer's disease ; Caregivers ; Clinical decision making ; Clinical trials ; Cognition disorders in old age ; Cognitive ability ; Cognitive Dysfunction - diagnosis ; Cognitive Dysfunction - therapy ; Decision making ; Dementia ; Dementia - diagnosis ; Dementia - drug therapy ; Dementia disorders ; Demographic aspects ; Diagnosis ; Donepezil ; Early Diagnosis ; Empirical analysis ; Galantamine ; Humans ; Impairment ; Independent Living ; Mass Screening - adverse effects ; Memantine ; Mental health screening ; Methods ; Neurodegenerative diseases ; Neuropsychological Tests ; Older people ; Patients ; Practice Guidelines as Topic ; Qualitative analysis ; Quality of life ; Rivastigmine ; Sensitivity and Specificity ; Signs and symptoms ; Synthesis ; Systematic review ; Task forces
  • É parte de: JAMA : the journal of the American Medical Association, 2020-02, Vol.323 (8), p.764-785
  • Notas: ObjectType-Article-2
    SourceType-Scholarly Journals-1
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  • Descrição: IMPORTANCE: Early identification of cognitive impairment may improve patient and caregiver health outcomes. OBJECTIVE: To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. DATA SOURCES: MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. STUDY SELECTION: Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. DATA EXTRACTION AND SYNTHESIS: Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. MAIN OUTCOMES AND MEASURES: Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. RESULTS: The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, –0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, –0.24 [95% CI, –0.36 to –0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. CONCLUSIONS AND RELEVANCE: Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.
  • Editor: United States: American Medical Association
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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