SCREENING FOR COGNITIVE IMPAIRMENT IN GENERAL-PRACTICE - TOWARD A CONSENSUS

We considered whether general practitioners should examine all older p atients over a certain age for cognitive impairment in screening for e arly dementia. We invited presentations from key experts, selectively reviewed the literature, and developed a consensus statement. The effi cacy of and benefits from unselective use of cognitive testing and inf ormant questionnaires for detecting early dementia in older patients a ttending general practice are limited. Positive predictive values of c ognitive screening for dementia are less than 50%, even for older pati ent populations. Higher values may be obtained by testing patients who have a relevant history of cognitive or functional decline. Whatever procedures are adopted for screening older general practice attenders for cognitive impairment or early dementia, investigation is still req uired into the relative merits of different health professionals perfo rming the screening, the positive and negative effects on patients and their families, and the cost-benefit ratio. The majority view of work shop participants was that cognitive testing should occur for older pa tients when there is a reason to suspect dementia. Testing may occur i n an individual considered to be at risk because of an informant histo ry of cognitive or functional decline, clinical observation, or, somet imes, very old age. No single instrument for cognitive screening is su itable for global use. Screening programs must be supported by trainin g and supplemented by education for professionals and families in mana gement of dementia.