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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through December 2012; systematic reviews; clinical trial registries; and experts.
  
  
  METHODS
  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.
  
  
  METHODS
  Dual quality assessment and abstraction of relevant study details.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Limited studies in persons with dementia other than Alzheimer disease and sparse reporting of important health outcomes.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Lin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Connor
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Rossom
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Perdue
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Eckstrom
mesh_terms: D000368:Aged; D017028:Caregivers; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003657:Decision Making; D003704:Dementia / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D015259:Dopamine Agents / Q000627:therapeutic use; D042241:Early Diagnosis; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008559:Memantine / Q000627:therapeutic use; D011581:Psychological Tests; D018570:Risk Assessment
chemical_list: D002800:Cholinesterase Inhibitors; D015259:Dopamine Agents; D008559:Memantine