Primary Care Dementia Screening Does Not Increase Depression or Anxiety
By Christopher Cheney
Screening for Alzheimer disease and related dementias (ADRD) in the primary care setting does not harm patients as measured by prevalence of depression and anxiety, recent research shows.
Primary care clinicians provide the most care to older adults, and at least half of primary care patients afflicted with ADRDs are never diagnosed with the conditions. For patients who do receive an ADRD diagnosis, the determination is often made two to five years after the onset of symptoms, which limits the benefits of early detection such as reducing family burden.
The recent research, which was published in the Journal of the American Geriatrics Society, examined data collected from 4,005 primary care patients over age 65. Half of the patients were screened for ADRDs and the other half served as a “no screen” control group.
“This is the ﬁrst randomized controlled trial to evaluate the beneﬁts and harms of population screening for ADRD among asymptomatic patients attending primary care. Our trial demonstrated no harm from screening, as measured by depressive and anxiety symptoms,” the research co-authors wrote.
To assess harm to patients, prevalence of depression was measured with the Patient Health Questionnaire-9 (PHQ-9) and prevalence of anxiety was measured with the Generalized Anxiety Disorder seven-item scale (GAD-7). Assessment of benefits to patients included data collected for health-related quality of life (HRQOL).
The assessments generated several key data points:
- At baseline for the ADRD screened group and the control group, the scores for the PHQ-9 and GAD-7 assessments were similar.
- At one month, six months, and 12 months for the ADRD screened group and the control group, the mean scores for the PHQ-9 and GAD-7 assessments remained similar.
- At baseline for the ADRD screened group and the control group, the mean HRQOL score was similar.
- At 12 months for the ADRD screened group and the control group, the mean HRQOL score remained similar.
“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,” the researchers wrote.
Interpreting the data
The research is a significant contribution to the debate over whether ADRD screening should be standard practice in the primary care setting, the lead author of the study told HealthLeaders.
“The results from this study are some of the first to show that screening for dementia does not increase harm for patients, as measured by an increase in depression or anxiety. They get us a step closer to determining if screening for dementia should be part of routine care for older adults,” said Nicole Fowler, PhD, an assistant professor of medicine at Indiana University School of Medicine in Indianapolis, and a research scientist at the Regenstrief Institute in Indianapolis.
Fowler said her research team is examining whether other harms may be linked to ADRD screening in the primary care setting. “For example, how does early detection of dementia via screening impact the older adults’ family members who might be in a position to be a caregiver?”
More research is also required to determine the benefits of ADRD screening, she said. “This study measured benefits of screening using measures of health-related quality of life, healthcare utilization, and creation of new advance care plans. We did not find benefits among these measures. But the caveat is that only 66% of the people who screened positive sought follow-up testing to determine if they had ADRD, and if so, received collaborative care.”
Future research on the benefits of ADRD screening need to account for essential actions after screening, Fowler said. “To truly determine benefit of screening, we need to ensure that screening is coupled with appropriate diagnostic follow-up and care for the patients and family.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.