Should Dementia Screenings Be Part of Routine Care?

Last updated: February 14, 2012

Here's a question for everyone who worries about a loved one's memory -- or every dementia caregiver who has ever wondered if his or her own memory is slipping: Would it be helpful if cognitive checks were done routinely, as part of a primary-care exam?

A new study in the Journal of the American Geriatrics Society reports that screenings with a two-minute "mini-cog" cognitive screening test increased the number of dementia cases detected by two- to threefold -- uncovering many cases that would otherwise have gone unnoticed by doctors.

Nearly 11 percent of the 8,000 veterans screened by the Minnesota Veterans Affairs Medical Center were found to have some form of cognitive impairment, compared to 4 percent in clinics that didn't use this test. All the vets were over 70 and had no known history of memory problems. More than 90 percent of the discovered impairments were confirmed in follow-up testing. (The mini-cog has many varieties; all are fast and easy -- this one involved remembering words and drawing a clock face.)

"I think there's increasing data in the last few years that unrecognized cognitive impairment leads to worse health outcomes," study leader Riley McCarten, a neurologist at the Minneapolis V.A., told The Minneapolis Star Tribune.

Detection of problems enables doctors to pinpoint and possibly treat possible non-Alzheimer's causes of dementia symptoms. Also, early detection allows families to deal with issues that memory loss may be affecting, like medication compliance, family finances, and to plan for the future.

The real fly in the ointment of early screenings, in the absence of a cure for Alzheimer's, is that it's often beyond the expertise and scope of a limited office visit for physicians to provide meaningful assistance re driving, finances, and social isolation, notes geriatrician Leslie Kernisan of the Over 60 Health Center in Berkeley, California. For that kind of help and information, families of those whose dementia is detected early have to look elsewhere. But at least having knowledge of what they're facing is better than being left in the dark.

Image by Flickr user SigNote Cloud, used under a Creative Commons license.

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11 Comments So Far. Add Your Wisdom.

over 2 years ago

Responding to the point by Anonymous who said from the heart when talking about his/her mother at age 102: "She's definitely slipping--but what good does it do anyone at this point to have a definitive diagnosis?" My Mom's two neurologists disagree about what info to share with my Mom regarding her diagnosis of dementia. However, both felt it was important for the family to know for many reasons, one being that some types of dementia may be heriditary (or partially). I personally would want to know my family history, even if family risk is not strongly correlated with particular types of dementia. I think it's fair that my children and grandchildren have the option of knowing family history of all medical illnesses, but perhaps everyone would not want to know or wish for their children to know.

Anonymous said over 2 years ago

I'm ambivilent. I'm the sole caretaker for my 102 year old mother, who has gotten more and more forgetful and sometime even a little combative in the past few months. She had a CAT scan for an unrelated matter that also showed some age-related conditions in her brain. I asked her doctor if she should be tested for Alzheimer's--he said that at her age we were lucky it was not much worse and that in any event there were really no effective treatments. She's definitely slipping--but what good does it do anyone at this point to have a definitive diagnosis? Very discouraging. The bottom line is that we need much more research.

over 2 years ago

I am 71, have already been tested for Dementia. Which they determined that I didn't have at this time. Currently taking Aricept, seems to help. My problem is short term memory loss,brain shrinkage. My doctor said that she would like to test me every time I go in to see her, I said no. She said that she could "stack" medications. I find this "testing" nerve racking.

over 2 years ago

To SDBabs - We had the same experience - marital arguments and anger because we did not know what was happening. Once we had the diagnosis, we researched the disease and learned how to deal with it. He is able to acknowledge rather than deny or get angry when I remind him about something. I now understand that he is not purposefully failing to follow through on important stuff.

over 2 years ago

There are so many culrpits in our modern society that are contributing to Dementia and Alzheimer Disease. These conditions are devestating to families, finances and our healthcare system. There should be more of a push for the information of avoidance, rather than screening!

over 2 years ago

I go back and forth on this; primarily, due to the last paragraph in Paula's article above. If we screen for dementia and are diagnosed what happens when there's no cure? What happens to insurance benefits going forward? You can't qualify for Long Term Care insurance if you're already diagnosed with certain pre-existing conditions. On the other hand, knowing sooner can lead to preventative measures that are not caused through, for example, Alzheimer's, vascular, or Lewy Body. A stressful episode leading to depression or a bad mix of medications can lead to dementia like symptoms and be more easily alleviated if diagnosed soon enough. What to do? Some major social systems of care must be changed first. Then we can get more people to participate in clinical trails, feel freer about being assessed and diagnosed then treated, because insurance will cover no matter what.

Anonymous said over 2 years ago

I don't know if this supposed to be a test or just double-checking their patient information, but my mother gets the same cross-examination everytime she goes to see any of her doctor's ... birthday, address, list of medications, etc.

over 2 years ago

I am glad to see this article since my relatives are not only concerned about my Mom and her wellbeing (she has three types of dementia), but are also concerned about their cognitive "futures." Early detection can help in getting people to take proactive measures before its too late (financial planning, rearranging the home or changing residence, removing "risky" objects or phasing out riskier activities in the home before patients get to the combative stage). For instance, if it seems dementia might be in my personal future, I could rechannel my spending and focus on long-term care insurance, or at least have more of a nest egg when the need arises I can afford getting help. Thank you for this article.

over 2 years ago

It should be part of routine screening. Our doctor failed-inspite of telling her and even writing a letter regarding odd behavior. He would not have quit paying for the long term care plan and other bills had we known what the problem was. We would not have had all the marital problems and anger ahd we known. Still, doctors don't have a clue.

over 2 years ago

Dementia screening should absolutely become part of routine care beginning at 50+. My husband lost out on thousands of dollars in long term disability insurance payments because he was not diagnosed with Alzheimers disease until months after he lost two job due to the inability to remember important facts and responsibilities. He paid disability insurance premiums at those employers.

over 2 years ago

It is obvious that the more you look for things whether it be diseases or dirt, the more you will find. It is to me an attempt for the author to broker fame and donations for a big DUH kind of discussion.

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