[Do not screen all elderly for cognitive impairment]

Abstract

Early and routine screening of older people for cognitive impairment is widely advocated as it is thought to support proactive interventions and improve treatment results. However, scientific evidence to support this strategy is lacking. The recent systematic review of screening instruments and interventions discussed in this commentary shows that the widely implemented Mini-mental state examination questionnaire (MMSE) is indeed adequate to confirm the diagnosis of dementia, and to a lesser extent also mild cognitive impairment. However, no pharmacological interventions have shown any convincing evidence of a positive effect in the groups selected by screening. Pharmacological treatment is often discontinued because of its side effects. No convincing evidence could be found to support the effect of any other caregiver-oriented intervention either. This commentary concludes that the MMSE can be used for diagnosing dementia in primary care, but should not be used for screening otherwise healthy older patients.