Why Experts Don't Want All Seniors to Get Screened for Dementia


Should all older adults undergo regular memory screening as part of their primary care regimen?

Probably not, says a government-appointed panel, after they failed to find enough proof in favor of—or against—conducting regular mental assessments on most elderly individuals.

“There is a critical gap in the evidence,” says Douglas Owens, M.D., M.S., a member of the task force. “More research is needed so we can better understand the benefits and risks of screening and understand the impact early detection can have on the lives of patients and their families.”

Every Medicare beneficiary is legally eligible to obtain no-cost screening for cognitive impairment during the annual “wellness” visit—a mandate that’s unlikely to change as a result of the panel’s ruling. But most aging adults don’t actively seek out this benefit unless they (or their family members) notice problems with memory or mental processing.

A physician who suspects an elder has cognitive impairment typically administers a series of written and oral exams to both the senior and their family member(s). This enables the primary care doctor to get a good sense for the aging adult’s overall health. Depending on the doctor’s determination, they may decide to refer the elder to a specialist, such as a neurologist or neuropsychiatrist, for further evaluation.

Experts agree that the earlier a source of cognitive impairment can be identified, the more impactful any intervention—medicinal or otherwise—will be; yet nearly 50 percent of people with dementia remain undiagnosed, according to the Alzheimer’s Association.

In some cases, dementia is a reversible condition brought on by one of several potential culprits, including: drug interactions, a malfunctioning thyroid, poor nutrition, depression, etc. Once the root cause has been treated, an individual’s cognitive issues are often resolved.

Other forms of dementia, such as Alzheimer’s and Lewy Body, don’t yet have truly effective treatments.

Especially in these instances, the benefits of early detection must be weighed against the emotional, social and financial costs that can result from a false positive diagnosis. A misdiagnosis of Alzheimer’s disease can cost a family upwards of $14,000 per year in additional healthcare costs and the stigma of Alzheimer’s places a heavy burden on those living with the disease.

Yet, even the experts can’t say for certain whether early detection of Alzheimer’s and other incurable types of dementia would truly be helpful for elders and their families.

For now, the task force recommends that people who are experiencing cognitive issues seek further evaluation from their doctor, while those whose minds still seem sharp should hold off. Caregivers and other family members can also help by keeping their eyes out for warning signs that an elderly family member needs help.

What do you think? Should all adults beyond a certain age receive regular cognitive exams, or should we wait until a cure or therapy for Alzheimer’s and other forms of dementia is discovered?

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After experiencing this with my mother, I really feel a regular screening after age 75 would be beneficial. Often times, family members live a long distance away. I was one of six children, and the only one nearby. My siblings would call Mom and she seemed fine. I would try to convince them that something was terribly wrong and against her wishes, I took her in for a screening. Most of the elderly's children are in a stage of denial (myself included). I really felt I could bring Mom into my home and take care of her. Once you get through the denial stage, it is difficult to understand that you are helpless with this disease.
I truly believe, had the medical staff detected early dementia signs, my Mom would have listened and sought some help. She did not feel I was accurate in my perception of her mental state. Hence, the siblings thought she was Ok. She died from Failure to Thrive and Alzheimer's in February.
My husband was diagnosed early, probably because I am in the medical profession. As painful as the terrible, awful, no good diagnosis of Alzheimers is--- I now know that my husband is not being contrary, I approach things more slowly, he has a terrific support system because everyone knows the situation. He has help with his golf scores with out embarrassment etc., etc., etc.,. Furthermore, we are able to talk openly, make plans for the future and prepare together for our new situation. I know of many families who are so angry at someone with Alzheimers because there has not been a dx and no family member is becoming educated about the disease progression. The powers that be do not want early dx because it will make more work for the system. Remember the Alzheimers association is open to any one with a family member with dementia----if you want to become educated. The best support there is at this time.
Thank you for this interesting article, Ann-Marie.

I don't see the point of routinely screening every elder every year when there are no symptoms. But that raises the question of who is around to notice the symptoms. Elders who live alone and have no family visiting often should probably have screening if the doctor has the slightest hint there might be a problem.

When there are symptoms or suspicions of cognitive impairment, then I think the earlier the screening the better. Sometimes, as this article points out, the causes are treatable. It would be wonderful to find out that a nutritional deficiency is the culprit and can easily be corrected!

Even with noncurable dementia, I think it is good to know as early as possible. For one thing, this gives everyone more time to plan. It inspires couples to finally take that cruise they've been putting off, while they both can still enjoy it.

And even when there is no cure, it is not really true that there are no effective treatments, at least for Lewy Body Dementia. The various symptoms can often be treated very successfully. A cure? No. An extension of the life span? No. Improvement to quality of life? Absolutely! I saw this with my own husband, and I see it over and over in my local support group.

I don't think it is as important for someone in her 90s to get an exact diagnosis as it is for someone in her 70s.