More than 180 Health and Alzheimer’s Groups Urge U.S. Task Force to Revise Stance and Encourage Cognitive Screening for Older Adults
Washington, D.C. (October 7, 2019) – A broad range of more than 180 health groups, Alzheimer’s-serving and other organizations and researchers today called on a federal task force to upgrade a draft recommendation on cognitive screenings for people 65 and older.
The U.S. Preventive Services Task Force (USPSTF), which makes recommendations about preventive clinical services contended in a draft recommendation that there is “insufficient” evidence to warrant doctors conducting cognitive screening for older adults. Public comments on the task force’s recommendations are due today.
The organizations, advocates and experts – including UsAgainstAlzheimer’s, American Academy of Neurology, Milken Institute, Alzheimer’s Drug Discovery Foundation, the LEAD Coalition, The Kennedy Forum, National Behavioral Health Council and YMCA of the USA – strongly disputed the task force’s draft recommendation. The groups urged the task force to revise its recommendation to one that would encourage health care providers to screen older patients for cognitive impairment.
“This draft recommendation would make it almost impossible to meet the nation’s goal to prevent or effectively treat Alzheimer’s by 2025,” said George Vradenburg, chairman and co-founder of UsAgainstAlzheimer’s. “The task force’s position on cognitive impairment screening would slow progress toward earlier diagnosis of dementia, improved care and services, and better outcomes for people with dementia and their families.”
The organizations said they believe the task force’s review is too narrowly constructed and overlooks the increasing body of evidence demonstrating the health benefits of screening. For example, screening can lead to early diagnosis and help identify forms of mild cognitive impairment that may be reversible and lead to treatments that can improve a person’s quality of life. A great deal of emerging evidence over the past five years supports the idea that Alzheimer’s and dementia can be slowed, delayed, or possibly even prevented through risk-modifying lifestyle changes. These studies show the importance of early detection and diagnosis.
The organizations warned in their comment letters that, if left unchanged, the task force’s recommendation of “I” for “insufficient” evidence risks reinforcing the discredited notion that health care providers only need to or ought to diagnose that which they are able to cure or treat with a pill or a surgical intervention.
“Think of the catastrophic damage done for decades in oncology and again during the early years of the HIV/AIDS epidemic – before effective biomedical treatments – from anti-detection biases which impeded efforts to account for the full scope of the public health burden, raise awareness and reduce stigma, generate data for bench and social science researchers and provide services and supports to improve quality of life for those with the condition,” said Ian Kremer, executive director of the LEAD Coalition. “The ‘I’ recommendation inadvertently equates to, and reinforces, ‘indifference’ toward the many non-cure benefits from early identification of cognitive impairment.”
A growing number of leading non-governmental organizations and federal agencies have updated their guidelines and practice in response to evidence on the net benefit of screening.
Just a few weeks ago, the American Academy of Neurology (AAN) updated its guidelines on cognitive impairment to encourage physicians to screen patients over age 65 using a validated screening tool. AAN noted that in the United States, the Medicare Annual Wellness Visit requires an assessment to detect cognitive impairment, and the organization said that clinicians assessing for cognitive impairment should use a brief, validated cognitive assessment instrument in addition to eliciting patient and informant history regarding cognitive concerns.
AAN joins organizations representing providers and patients that have called for increased screening more generally as an effective tool to fight disease, including the American Diabetes Association, American Heart Association, Endocrine Society, National Academy of Neuropsychology, Alzheimer’s Foundation of America, the Heart Failure Society of America and the UsA2 Brain Health Partnership.
In addition, at the same time that the task force is saying there is insufficient evidence for screening, major federal agencies are working to make screenings more available to older Americans. Agencies within the Department of Health and Human Services have been taking decisive steps to advance detection, diagnosis, medical care, residential and home and community-based services, family caregiver support, and research participation.