Screening for cognitive impairment in older adults: A systematic review for the U.S. preventive services task force

Jennifer S. Lin, Elizabeth O'Connor, C. Rossom, Leslie A. Perdue, Elizabeth Eckstrom

Research output: Contribution to journalArticle

186 Citations (Scopus)

Abstract

Background: Earlier identification of cognitive impairment may reduce patient and caregiver morbidity. Purpose: To systematically review the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment. Data Sources: MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through December 2012; systematic reviews; clinical trial registries; and experts. Study Selection: English-language studies of fair to good quality, primary care-feasible screening instruments, and treatments aimed at persons with mild cognitive impairment or mild to moderate dementia. Data Extraction: Dual quality assessment and abstraction of relevant study details. Data Synthesis: The Mini-Mental State Examination (k = 25) is the most thoroughly studied instrument but is not available for use without cost. Publicly available instruments with adequate test performance to detect dementia include the Clock Drawing Test (k = 7), Mini-Cog (k = 4), Memory Impairment Screen (k = 5), Abbreviated Mental Test (k = 4), Short Portable Mental Status Questionnaire (k = 4), Free and Cued Selective Reminding Test (k = 2), 7-Minute Screen (k = 2), and Informant Questionnaire on Cognitive Decline in the Elderly (k = 5). Medications approved by the U.S. Food and Drug Administration for Alzheimer disease (k = 58) and caregiver interventions (k = 59) show a small benefit of uncertain clinical importance for patients and their caregivers. Small benefits are also limited by common adverse effects of acetylcholinesterase inhibitors and limited availability of complex caregiver interventions. Although promising, cognitive stimulation (k = 6) and exercise (k = 10) have limited evidence to support their use in persons with mild to moderate dementia or mild cognitive impairment. Limitation: Limited studies in persons with dementia other than Alzheimer disease and sparse reporting of important health outcomes. Conclusion: Brief instruments to screen for cognitive impairment can adequately detect dementia, but there is no empirical evidence that screening improves decision making. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear. Primary Funding Source: Agency for Healthcare Research and Quality.

Original languageEnglish (US)
Pages (from-to)601-612
Number of pages12
JournalAnnals of Internal Medicine
Volume159
Issue number9
StatePublished - Nov 5 2013

Fingerprint

Advisory Committees
Caregivers
Dementia
Alzheimer Disease
Intelligence Tests
Quality of Health Care
Information Storage and Retrieval
Health Services Research
Cholinesterase Inhibitors
United States Food and Drug Administration
Cognitive Dysfunction
MEDLINE
Registries
Primary Health Care
Decision Making
Language
Clinical Trials
Exercise
Morbidity
Costs and Cost Analysis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Screening for cognitive impairment in older adults : A systematic review for the U.S. preventive services task force. / Lin, Jennifer S.; O'Connor, Elizabeth; Rossom, C.; Perdue, Leslie A.; Eckstrom, Elizabeth.

In: Annals of Internal Medicine, Vol. 159, No. 9, 05.11.2013, p. 601-612.

Research output: Contribution to journalArticle

Lin, Jennifer S. ; O'Connor, Elizabeth ; Rossom, C. ; Perdue, Leslie A. ; Eckstrom, Elizabeth. / Screening for cognitive impairment in older adults : A systematic review for the U.S. preventive services task force. In: Annals of Internal Medicine. 2013 ; Vol. 159, No. 9. pp. 601-612.
@article{e13ebf4f29f94d85ae33b10f258455c2,
title = "Screening for cognitive impairment in older adults: A systematic review for the U.S. preventive services task force",
abstract = "Background: Earlier identification of cognitive impairment may reduce patient and caregiver morbidity. Purpose: To systematically review the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment. Data Sources: MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through December 2012; systematic reviews; clinical trial registries; and experts. Study Selection: English-language studies of fair to good quality, primary care-feasible screening instruments, and treatments aimed at persons with mild cognitive impairment or mild to moderate dementia. Data Extraction: Dual quality assessment and abstraction of relevant study details. Data Synthesis: The Mini-Mental State Examination (k = 25) is the most thoroughly studied instrument but is not available for use without cost. Publicly available instruments with adequate test performance to detect dementia include the Clock Drawing Test (k = 7), Mini-Cog (k = 4), Memory Impairment Screen (k = 5), Abbreviated Mental Test (k = 4), Short Portable Mental Status Questionnaire (k = 4), Free and Cued Selective Reminding Test (k = 2), 7-Minute Screen (k = 2), and Informant Questionnaire on Cognitive Decline in the Elderly (k = 5). Medications approved by the U.S. Food and Drug Administration for Alzheimer disease (k = 58) and caregiver interventions (k = 59) show a small benefit of uncertain clinical importance for patients and their caregivers. Small benefits are also limited by common adverse effects of acetylcholinesterase inhibitors and limited availability of complex caregiver interventions. Although promising, cognitive stimulation (k = 6) and exercise (k = 10) have limited evidence to support their use in persons with mild to moderate dementia or mild cognitive impairment. Limitation: Limited studies in persons with dementia other than Alzheimer disease and sparse reporting of important health outcomes. Conclusion: Brief instruments to screen for cognitive impairment can adequately detect dementia, but there is no empirical evidence that screening improves decision making. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear. Primary Funding Source: Agency for Healthcare Research and Quality.",
author = "Lin, {Jennifer S.} and Elizabeth O'Connor and C. Rossom and Perdue, {Leslie A.} and Elizabeth Eckstrom",
year = "2013",
month = "11",
day = "5",
language = "English (US)",
volume = "159",
pages = "601--612",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "9",

}

TY - JOUR

T1 - Screening for cognitive impairment in older adults

T2 - A systematic review for the U.S. preventive services task force

AU - Lin, Jennifer S.

AU - O'Connor, Elizabeth

AU - Rossom, C.

AU - Perdue, Leslie A.

AU - Eckstrom, Elizabeth

PY - 2013/11/5

Y1 - 2013/11/5

N2 - Background: Earlier identification of cognitive impairment may reduce patient and caregiver morbidity. Purpose: To systematically review the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment. Data Sources: MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through December 2012; systematic reviews; clinical trial registries; and experts. Study Selection: English-language studies of fair to good quality, primary care-feasible screening instruments, and treatments aimed at persons with mild cognitive impairment or mild to moderate dementia. Data Extraction: Dual quality assessment and abstraction of relevant study details. Data Synthesis: The Mini-Mental State Examination (k = 25) is the most thoroughly studied instrument but is not available for use without cost. Publicly available instruments with adequate test performance to detect dementia include the Clock Drawing Test (k = 7), Mini-Cog (k = 4), Memory Impairment Screen (k = 5), Abbreviated Mental Test (k = 4), Short Portable Mental Status Questionnaire (k = 4), Free and Cued Selective Reminding Test (k = 2), 7-Minute Screen (k = 2), and Informant Questionnaire on Cognitive Decline in the Elderly (k = 5). Medications approved by the U.S. Food and Drug Administration for Alzheimer disease (k = 58) and caregiver interventions (k = 59) show a small benefit of uncertain clinical importance for patients and their caregivers. Small benefits are also limited by common adverse effects of acetylcholinesterase inhibitors and limited availability of complex caregiver interventions. Although promising, cognitive stimulation (k = 6) and exercise (k = 10) have limited evidence to support their use in persons with mild to moderate dementia or mild cognitive impairment. Limitation: Limited studies in persons with dementia other than Alzheimer disease and sparse reporting of important health outcomes. Conclusion: Brief instruments to screen for cognitive impairment can adequately detect dementia, but there is no empirical evidence that screening improves decision making. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear. Primary Funding Source: Agency for Healthcare Research and Quality.

AB - Background: Earlier identification of cognitive impairment may reduce patient and caregiver morbidity. Purpose: To systematically review the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment. Data Sources: MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through December 2012; systematic reviews; clinical trial registries; and experts. Study Selection: English-language studies of fair to good quality, primary care-feasible screening instruments, and treatments aimed at persons with mild cognitive impairment or mild to moderate dementia. Data Extraction: Dual quality assessment and abstraction of relevant study details. Data Synthesis: The Mini-Mental State Examination (k = 25) is the most thoroughly studied instrument but is not available for use without cost. Publicly available instruments with adequate test performance to detect dementia include the Clock Drawing Test (k = 7), Mini-Cog (k = 4), Memory Impairment Screen (k = 5), Abbreviated Mental Test (k = 4), Short Portable Mental Status Questionnaire (k = 4), Free and Cued Selective Reminding Test (k = 2), 7-Minute Screen (k = 2), and Informant Questionnaire on Cognitive Decline in the Elderly (k = 5). Medications approved by the U.S. Food and Drug Administration for Alzheimer disease (k = 58) and caregiver interventions (k = 59) show a small benefit of uncertain clinical importance for patients and their caregivers. Small benefits are also limited by common adverse effects of acetylcholinesterase inhibitors and limited availability of complex caregiver interventions. Although promising, cognitive stimulation (k = 6) and exercise (k = 10) have limited evidence to support their use in persons with mild to moderate dementia or mild cognitive impairment. Limitation: Limited studies in persons with dementia other than Alzheimer disease and sparse reporting of important health outcomes. Conclusion: Brief instruments to screen for cognitive impairment can adequately detect dementia, but there is no empirical evidence that screening improves decision making. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear. Primary Funding Source: Agency for Healthcare Research and Quality.

UR - http://www.scopus.com/inward/record.url?scp=84887862604&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887862604&partnerID=8YFLogxK

M3 - Article

C2 - 24145578

AN - SCOPUS:84887862604

VL - 159

SP - 601

EP - 612

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 9

ER -