Should Older Adults Be Screened for Cognitive Impairment?

Soo Borson, MD


Medscape General Medicine. 2004;6(1):e48 

In This Article


For the last decade or more, published practice guidelines have favored early detection and treatment of dementias of late life but have generally offered only education about dementia for primary care physicians as the means of achieving it. Screening has been encouraged only for patients who have symptoms suggesting cognitive impairment, but numerous studies have shown that physicians miss many diagnosable cases of dementia. Cognitive screening of older adults in general could detect noncomplaining but impaired individuals whose deficits have not yet become obvious, but expert opinion has been divided as to whether the cost of widespread screening would be tolerable to patients, families, health systems, and third-party payers. The validation of newer, more rapid dementia screening tools, easily applied by nonspecialists with minimal training and no special equipment, calls for review of the prevailing wisdom and challenges the view that only "symptomatic" patients should be screened. With the advent of useful treatment for dementia, screening could serve a purpose both useful to the patient and meaningful to the clinician. This paper examines the rationale for cognitive screening and methods for general application in medical care settings.

Alzheimer's disease (AD), the most common of the dementias of late life worldwide, affects an estimated 3-4 million older Americans, with expectations of at least triple that number within a generation. Other dementias, sometimes coexisting with or misdiagnosed as AD, are relatively less prevalent but still account for as many as 45% of cases, bringing to 5-7 million the current total number of elderly persons in the United States who experience everyday functional deficits caused by cognitive impairment. The principal basis for this epidemic of late-life dementias is aging itself, as the incidence of neurodegenerative brain diseases rises dramatically in the last half of life, and cognitive impairment is the most disabling of the chronic conditions associated with aging.[1]