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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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. J Am Geriatr Soc 68:535–543, 2020
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Although CSF Aβ1-42/1-40 ratio and amyloid PET are considered interchangeable, CSF tau biomarkers have only correlated weakly with brain tau as measured by radioligands.
“Although CSF Aβ1–42/1–40 ratio and amyloid PET are now considered interchangeable,191 CSF tau biomarkers have only correlated weakly with brain tau as currently measured by radioligands.192”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [192]
Citation 192 is attached to the claim about CSF tau biomarkers and radioligand-measured brain tau. The Methods and Discussion of the IU CHOICE trial address primary-care cognitive screening, not that biomarker correlation; searches for CSF tau, tau PET, and radioligands found no relevant passage in our copy. No page numbers were provided for the indexed passages. (LLM, conf=0.77)
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Fatores que influenciam o rebaixamento cognitivo de pessoas idosas
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Additional file 3 of Dementia and comorbidities in primary care: a scoping review
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Additional file 1 of Dementia and comorbidities in primary care: a scoping review
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Additional file 2 of Dementia and comorbidities in primary care: a scoping review
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Self-citation
- Authors
- Fowler, N. R., Perkins, A. J., Gao, S., Sachs, G. A., & Boustani, M. A.
- Affiliations
- Regenstrief Institute (US)
- Indiana University Indianapolis (US)
- Corresponding author
- Fowler, Nicole R.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2019-12-02
- Volume
- 68
- Issue
- 3
- Pages
- 535-543
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC7187902
- OpenAlex
- W2991026540
- Cited by
- 79
- References
- 54
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 11 · 2023: 14 · 2022: 11 · 2021: 8 · 2020: 12
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- Funders
- National Institute on Aging (R01AG040220)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- dementia screening, Alzheimer's disease and related dementias, primary care, older adults, health-related quality of life, depressive symptoms, anxiety symptoms, Mini-Cog, screening harms, advance care planning, health care utilization, comparative effectiveness
- MeSH terms
- Aged, Dementia, Female, Humans, Indiana, Male, Mass Screening, Neuropsychological Tests, Primary Health Care, Quality of Life, Universities, Outcome Assessment, Health Care, Risk Assessment
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