Summary
The UK National Screening Committee (UK NSC) has upheld previous recommendations against screening people aged 65 and over for dementia. This decision follows an extensive review of the evidence.
The UK NSC has concluded that tests for dementia, which are largely questionnaire-based, do not – at present – accurately identify people who have dementia. Any recommendation in favour of screening would have required the UK NSC to be confident that acting earlier on a diagnosis might facilitate treatments to slow or prevent dementia.
The practical impact which this ruling may have (if any?) on high-profile dementia case finding programmes underway in the UK, whether in hospitals or in primary care, is an elephant-in-the-room question for others to debate.
The UK NSC will review these recommendations again after three years, or earlier if significant new evidence / new diagnostic techniques arise.
Reference
Recommendation against national dementia screening. London: Public Health England, January 14th 2015.
Further information (including a brief Screening for dementia FAQ / Q&A) is available:
Reference
The UK NSC recommendation on Screening for Dementia. London [Online]: UK National Screening Committee, January 2015.
This relates to a specially commissioned review:
Reference
Pittam, G. [and] Allaby, M. (2015). Screening for dementia: can screening bring benefits to those with unrecognised dementia, their carers and society? An appraisal against UKNSC criteria. A report for the UK National Screening Committee. Oxford: Solutions for Public Health (SPH), January 14th 2015.
This review draws heavily on a US based systematic review:
Reference
Lin, JS. O’Connor, E. Rossom, RC. [et al] (2013). Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine. November 5th 2013; 159(9): 601-12. Review.
Related guidance:
Reference
Moyer, VA; U.S. Preventive Services Task Force (2014) Screening for cognitive impairment in older adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. June 3rd 2014; 160(11): 791-7.
See further, the full US report:
Reference
Lin, JS. O’Connor, E. [and] Rossom, RC. [et al] (2013). Screening for cognitive impairment in older adults: an evidence update for the u.s. preventive services task force. Rockville (MD) [Online]: Agency for Healthcare Research and Quality (US), November 2013.
There is reported to be “very limited benefit of screening for dementia”
Reference
Mate, KE. Magin, PJ. [and] Brodaty, H. [et al] (2017). An evaluation of the additional benefit of population screening for dementia beyond a passive case-finding approach. International Journal of Geriatric Psychiatry. March 2017; 32(3): 316-323.
Concerning Screening (Non-Dementia) Generally: Counter-Intuitive Evidence
A review of currently available screening tests (19 diseases, 39 tests) for diseases, where death is a common outcome, found that reductions in mortality were uncommon, very rare or non-existent.
Reference
Saquib, N. Saquib, J. [and] Ioannidis, JP. (2015). Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials. International Journal of Epidemiology. January 15th 2015, [Epub ahead of print]. (Click here to view the PubMed abstract).
Blissfully Oblivious?: Screening Rarely Thought to Have Any Connection With Overdiagnosis
A recent survey of Australians concerning their opinions about / understanding of the term “Overdiagnosis” found that nobody identified this construct as being related to screening risk.
“Strategies to inform people about the risk of overdiagnosis associated with screening and diagnostic tests, in clinical and public health settings, could build on a nascent understanding of the nature of the problem”.
Reference
Moynihan, R. Nickel, B. [and] Hersch, J. [et al] (2015). What do you think overdiagnosis means? A qualitative analysis of responses from a national community survey of Australians. BMJ Open. May 19th 2015, Vol.5(5), e007436. (Click here to view the PubMed abstract).
