Medicare will pay for screening for cognitive impairment, but that doesn’t mean it’s necessarily a good idea.
The U.S. Preventive Services Task Force said in March that there isn’t enough scientific evidence to make the call.
That’s the same conclusion that the task force, an independent panel of medical experts, came to more than a decade ago, when it last evaluated dementia screening. Patient advocates say the evidence is crystal clear in one respect: More research needs to be done.
“It’s kind of a Catch-22,” says Dean Hartley, director of science initiatives at the Alzheimer’s Association. The USPSTF “believes there are tests that are of value, but there’s not enough evidence. But we need to collect that evidence to suggest that this is something we should do on an annual basis.”
Dementia screenings are typically short questionnaires that test memory, attention, language and/or visuospatial skills, among other things. One of the most common, the mini-mental state examination, consists of 30 questions and may be completed in about 10 minutes.
When the USPSTF evaluated the evidence related to screening tests, it found that while some tests could accurately identify dementia, there wasn’t enough evidence to show that there was either benefit or harm in routine screening of people over 65. There wasn’t enough evidence to show that screening decisively affected people’s treatment or decision making and planning, among other things.
Under the Affordable Care Act, Medicare beneficiaries are entitled to an annual wellness visit with no out-of-pocket charge. In addition to routine check-up items like measuring weight and blood pressure, the visit covers an evaluation for cognitive impairment.
The Alzheimer’s Association recommends that seniors undergo cognitive impairment screening and evaluation with a trained medical professional to establish a baseline for comparison, and then have regular follow-up assessments in subsequent years.
Alzheimer’s disease is the sixth leading cause of death, killing more than 83,000 people annually. It accounts for up to 80 percent of all dementia cases. Other types of dementia include vascular dementia, many cases of Parkinson’s disease and Huntington’s disease.
“We recognize this is an important disease of high consequence, and a problem that will only increase over time,” says Dr. Albert Siu, professor and chair of geriatrics and palliative care at Mount Sinai School of Medicine in New York, who was co-vice chair of the task force on dementia screening. “We are hopeful that in coming years when we have to revise this recommendation we’ll have better evidence on effectiveness of early diagnosis. But we’re not there in 2014.”