Risks and Benefits of Screening for Dementia in Primary Care: The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (IU CHOICE)Trial

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Abstract

BACKGROUND/OBJECTIVE: The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care. DESIGN, SETTING, AND PARTICIPANTS: Single-blinded, two-arm, randomized controlled trial (October 2012-September 2016) in urban, suburban, and rural primary care settings in Indiana. A total of 4005 primary care patients (aged ≥65 years) were randomized to ADRD screening (n = 2008) or control (n = 1997). INTERVENTION: Patients were screened using the Memory Impairment Screen or the Mini-Cog and referred for a voluntary follow-up diagnostic assessment if they screened positive on either or both screening tests. MEASUREMENTS: Primary measures were health-related quality of life (HRQOL; Health Utilities Index) at 12 months, depressive symptoms (Patient Health Questionnaire-9), and anxiety symptoms (Generalized Anxiety Disorder seven-item scale) at 1 month. RESULTS: The mean age was 74.2 years (SD = 6.9 years); 2257 (66%) were female and 2301 (67%) were white. At 12 months, we were unable to detect differences in HRQOL between the groups (effect size = 0.009 [95% confidence interval {CI} = −0.063 to 0.080]; P =.81). At 1 month, differences in mean depressive symptoms (mean difference = −0.23 [90% CI = −0.42 to -0.039]) and anxiety symptoms (mean difference = −0.087 [90% CI = −0.246 to 0.072]) were within prespecified equivalency range. Scores for depressive and anxiety symptoms were similar between the groups at all time points. No differences in healthcare utilization, advance care planning, and ADRD recognition by physicians were detected at 12 months. CONCLUSION: We were unable to detect a difference in HRQOL for screening for ADRD among older adults. We found no harm from screening measured by symptoms of depression or anxiety. Missing data, low rates of dementia detection, and high rate of refusal for follow-up diagnostic assessments after a positive screen may explain these findings.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Dementia
Primary Health Care
Alzheimer Disease
Health
Anxiety
Depression
Confidence Intervals
Advance Care Planning
Anxiety Disorders
Randomized Controlled Trials
Quality of Life
Delivery of Health Care
Physicians

Keywords

  • Alzheimer disease
  • dementia
  • screening

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{331793321c6243a1adb8d5130afddcfb,
title = "Risks and Benefits of Screening for Dementia in Primary Care: The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (IU CHOICE)Trial",
abstract = "BACKGROUND/OBJECTIVE: The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care. DESIGN, SETTING, AND PARTICIPANTS: Single-blinded, two-arm, randomized controlled trial (October 2012-September 2016) in urban, suburban, and rural primary care settings in Indiana. A total of 4005 primary care patients (aged ≥65 years) were randomized to ADRD screening (n = 2008) or control (n = 1997). INTERVENTION: Patients were screened using the Memory Impairment Screen or the Mini-Cog and referred for a voluntary follow-up diagnostic assessment if they screened positive on either or both screening tests. MEASUREMENTS: Primary measures were health-related quality of life (HRQOL; Health Utilities Index) at 12 months, depressive symptoms (Patient Health Questionnaire-9), and anxiety symptoms (Generalized Anxiety Disorder seven-item scale) at 1 month. RESULTS: The mean age was 74.2 years (SD = 6.9 years); 2257 (66{\%}) were female and 2301 (67{\%}) were white. At 12 months, we were unable to detect differences in HRQOL between the groups (effect size = 0.009 [95{\%} confidence interval {CI} = −0.063 to 0.080]; P =.81). At 1 month, differences in mean depressive symptoms (mean difference = −0.23 [90{\%} CI = −0.42 to -0.039]) and anxiety symptoms (mean difference = −0.087 [90{\%} CI = −0.246 to 0.072]) were within prespecified equivalency range. Scores for depressive and anxiety symptoms were similar between the groups at all time points. No differences in healthcare utilization, advance care planning, and ADRD recognition by physicians were detected at 12 months. CONCLUSION: We were unable to detect a difference in HRQOL for screening for ADRD among older adults. We found no harm from screening measured by symptoms of depression or anxiety. Missing data, low rates of dementia detection, and high rate of refusal for follow-up diagnostic assessments after a positive screen may explain these findings.",
keywords = "Alzheimer disease, dementia, screening",
author = "Fowler, {Nicole R.} and Perkins, {Anthony J.} and Sujuan Gao and Sachs, {Greg A.} and Boustani, {Malaz A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jgs.16247",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Risks and Benefits of Screening for Dementia in Primary Care

T2 - The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (IU CHOICE)Trial

AU - Fowler, Nicole R.

AU - Perkins, Anthony J.

AU - Gao, Sujuan

AU - Sachs, Greg A.

AU - Boustani, Malaz A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND/OBJECTIVE: The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care. DESIGN, SETTING, AND PARTICIPANTS: Single-blinded, two-arm, randomized controlled trial (October 2012-September 2016) in urban, suburban, and rural primary care settings in Indiana. A total of 4005 primary care patients (aged ≥65 years) were randomized to ADRD screening (n = 2008) or control (n = 1997). INTERVENTION: Patients were screened using the Memory Impairment Screen or the Mini-Cog and referred for a voluntary follow-up diagnostic assessment if they screened positive on either or both screening tests. MEASUREMENTS: Primary measures were health-related quality of life (HRQOL; Health Utilities Index) at 12 months, depressive symptoms (Patient Health Questionnaire-9), and anxiety symptoms (Generalized Anxiety Disorder seven-item scale) at 1 month. RESULTS: The mean age was 74.2 years (SD = 6.9 years); 2257 (66%) were female and 2301 (67%) were white. At 12 months, we were unable to detect differences in HRQOL between the groups (effect size = 0.009 [95% confidence interval {CI} = −0.063 to 0.080]; P =.81). At 1 month, differences in mean depressive symptoms (mean difference = −0.23 [90% CI = −0.42 to -0.039]) and anxiety symptoms (mean difference = −0.087 [90% CI = −0.246 to 0.072]) were within prespecified equivalency range. Scores for depressive and anxiety symptoms were similar between the groups at all time points. No differences in healthcare utilization, advance care planning, and ADRD recognition by physicians were detected at 12 months. CONCLUSION: We were unable to detect a difference in HRQOL for screening for ADRD among older adults. We found no harm from screening measured by symptoms of depression or anxiety. Missing data, low rates of dementia detection, and high rate of refusal for follow-up diagnostic assessments after a positive screen may explain these findings.

AB - BACKGROUND/OBJECTIVE: The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care. DESIGN, SETTING, AND PARTICIPANTS: Single-blinded, two-arm, randomized controlled trial (October 2012-September 2016) in urban, suburban, and rural primary care settings in Indiana. A total of 4005 primary care patients (aged ≥65 years) were randomized to ADRD screening (n = 2008) or control (n = 1997). INTERVENTION: Patients were screened using the Memory Impairment Screen or the Mini-Cog and referred for a voluntary follow-up diagnostic assessment if they screened positive on either or both screening tests. MEASUREMENTS: Primary measures were health-related quality of life (HRQOL; Health Utilities Index) at 12 months, depressive symptoms (Patient Health Questionnaire-9), and anxiety symptoms (Generalized Anxiety Disorder seven-item scale) at 1 month. RESULTS: The mean age was 74.2 years (SD = 6.9 years); 2257 (66%) were female and 2301 (67%) were white. At 12 months, we were unable to detect differences in HRQOL between the groups (effect size = 0.009 [95% confidence interval {CI} = −0.063 to 0.080]; P =.81). At 1 month, differences in mean depressive symptoms (mean difference = −0.23 [90% CI = −0.42 to -0.039]) and anxiety symptoms (mean difference = −0.087 [90% CI = −0.246 to 0.072]) were within prespecified equivalency range. Scores for depressive and anxiety symptoms were similar between the groups at all time points. No differences in healthcare utilization, advance care planning, and ADRD recognition by physicians were detected at 12 months. CONCLUSION: We were unable to detect a difference in HRQOL for screening for ADRD among older adults. We found no harm from screening measured by symptoms of depression or anxiety. Missing data, low rates of dementia detection, and high rate of refusal for follow-up diagnostic assessments after a positive screen may explain these findings.

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KW - dementia

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