In March 2014 the U.S. Prevention Services Task Force presented its update on “Screening for Cognitive Impairment in Older Adults,” meaning more than 65 years of age.

Summarizing the results can be done in one word only: devastating. But let them speak for themselves: “The USPSTF found no evidence on the direct benefits and harms of screening for cognitive impairment. Evidence is adequate that some screening tools can accurately identify dementia. Treatment of mild to moderate dementia with several drug therapies and nonpharmacologic interventions results in small improvements in measures of cognitive function and caregiver outcomes, but the clinical significance of these improvements is uncertain. Evidence on the harms of screening and nonpharmacologic interventions is inadequate. The USPSTF found adequate evidence that AChEIs(=most medications) are associated with adverse effects, some of which are serious.”

Dementia is characterized by a memory decline severe enough to affect social functioning and often patients also exhibit behavioral and psychological symptoms. There are different causes for dementia, noteworthy is vascular dementia which affects 10-30% of sufferers. This type of dementia can be prevented by treating consequently the well-known risk factors for heart disease, however this has to happen much earlier in live. The chance of acquiring dementia increases with age, which is the strongest risk factor for most of us; 5% in persons aged 71 to 79 years, 24% in those aged 80 to 89 years, and 37% in those older than 90 years.

In this context it is worthwhile to mention Mild Cognitive Impairment (MCI) which is different from dementia in a way that the cognitive impairment is not severe enough to interfere with activities of daily living. It is difficult to estimate the prevalence of MCI, estimates range widely, from 3% to 42% in adults aged 65 years and older. The rate of progression to dementia is uncertain. Thus screening healthy individuals, may pick up on those, although they will remain happy and independent throughout their lives. This is one reason, why screening could be harmful. One study in primary care provides some information on the potential harms: 3573 older adults were screened and approximately one half of patients who had a positive screening result for cognitive impairment (207 out of 434 patients) declined a formal diagnostic work-up for dementia meaning they did not want to know.

The USPSTF found also inadequate evidence on the benefits of screening for cognitive impairment. This had to be expected with their assessment of the treatment options of dementia sufferers:  “Evidence shows that several drug therapies have a small effect on cognitive function measures in the short term, but the magnitude of the clinically relevant benefit is uncertain. There is evidence that interventions targeted to caregivers have a small effect on measures of caregiver burden and depression, but the magnitude of the clinically relevant benefit is uncertain.” This means that the effect of medication is measured with questionnaires and not by assessing improvements in daily life, apart from the known limited period of potential effectiveness of the medication – and this fortunately means a definite good-bye to raising false hopes by promising a magic wand. Thus we only can rely on leading a healthy life and keeping our mind sharp, the only weapons proven to somewhat reduce the risk of dementia.