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Dementia Screening

January 2008 - A recent commentary arguing against routine screening for dementia by physicians working in primary care settings has been published in the Journal of the American Medical Association.

Geriatrician Dr Malaz Boustani of the Indiana University School of Medicine said:

"To screen without symptoms, unless there is a suspicion of a problem, either by the individual, caregivers, or a physician, may led to negative consequences for the person and for society. There currently is no accurate screening test and we would be faced with an unacceptable number of false positives and false negatives. If we focus on dementia red flags we will be identifying individuals who will have a very high probability of having dementia and be able to focus our resources, including diagnostic testing, on these people."

The author explains that, according to the Alzheimer's Association, someone in the United States develops this disease every 72 seconds. The average primary care physician sees 2000 patients per year of whom 300 are aged 65 or older and 24 of these individuals will develop dementia. It is estimated that the American healthcare system misses between 60 and 80 per cent of individuals with dementia. Current initiatives are testing ways to help physicians identify dementia "red flags" in their patients to improve diagnosis. Early warning signs include problems complying with medication, taking more than seven prescribed medications, agitation, multiple falls, and more than two hospitalizations or emergency department visits in the past year.

The author concludes that despite the major disease burden caused by dementia, the potential benefit of conducting general population-based screening in non-symptomatic individuals remains inconclusive. Potential harm includes stigma, loss of long term care insurance, emotional dislocation for the individual and family, and reallocation of resources from other health problems.

Malaz Boustani concludes:

"Pressures to institute screening of unproven benefit could divert much needed resources from the health and social care systems and have an overall negative impact on care for patients with dementia and other illnesses, ultimately delaying the point when dementia screening becomes indicated. The goal should continue to be the best possible care for the most patients, which currently does not include screening for dementia."

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