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  • USPSTF: More Research Needed on Routine Cognitive Impairment Screenings

    Though US Preventive Services Task Force (USPSTF) acknowledges that there may be "important reasons" to screen for cognitive impairment for adults over 65 with no recognized signs or symptoms of impairment, 10 years after its last investigation of the issue the group continues to say that more research is needed before it can reach a recommendation about the benefits and risks of the assessments.

    The recent USPSTF report does not recommend against the screenings and even asserts that some screening tools are better supported by performance data than they were during the group's 2003 review of the issue. However, the overarching message from the report is clear: "the overall evidence is insufficient" for the USPSTF to advise for or against.

    Within that general position, the task force did arrive at a few related conclusions. Among them:

    • Some drug therapies "have a small effect" on short-term outcome measures for patients with mild to moderate dementia.
    • Caregiver interventions have a "small effect" on caregiver burden and depression.
    • Exercise interventions "are not associated with serious adverse effects."
    • Acetylcholinesterase inhibitors (AChEls) can produce adverse effects, some serious.

    APTA responded to the USPSTF report during a comment period in late November 2013. In a letter based on expert member input, the association noted that a physical therapist's (PT's) screening for cognitive function can "significantly affect how [PT] interventions are communicated and delivered to the patient." While the comment letter did acknowledge that there was insufficient evidence to recommend routine screening for the public, APTA input pointed out that a patient's cognitive status "can have profound implications" on treatment approaches and outcomes in settings that involve PTs.

    Additionally, APTA suggested changes to the report, many of which were incorporated into the final document. One such change: including exercise among the nonpharmacological interventions for adults with cognitive impairment.

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