INDIANAPOLIS Primary care physicians should focus on "dementia red flags" rather than routinely screen individuals with no dementia symptoms just because they've reached a certain age, according to Malaz Boustani, M.D., MPH, of the Indiana University School of Medicine and the Regenstrief Institute, Inc. and colleagues from the University of Kent and the University of Cambridge in the United Kingdom in a commentary published in the Nov. 28 issue of the Journal of the American Medical Association.
To screen without symptoms, unless there is a suspicion of a problem, either by the individual, caregivers, or a physician, may led to negative consequences for the person and for society says Dr. Boustani, who is a geriatrician.
There currently is no accurate screening test and we would be faced with an unacceptable number of false positives and false negatives. If we focus on dementia red flags we will be identifying individuals who will have a very high probability of having dementia and be able to focus our resources, including diagnostic testing, on these people, Dr. Boustani says.
Dementia red flags include medication adherence problems, more than 7 prescribed medications, agitation, multiple falls, and more than 2 hospitalizations or emergency department visits in the past year. Dr. Boustani, who says the healthcare system in the United States misses between 60% and 80% of individuals with dementia, is currently testing ways to help physicians identify dementia red flags in their patients so these missed individuals can be helped.
Someone in the United States develops Alzheimer disease every 72 seconds, according to the Alzheimers Association. The average primary care physician sees 2,000 patients per year of whom 300 are aged 65 or older. Of these 24 will develop dementia.
Despite this burden of disease, the benefit-harm ratio of conducting general population-based screening has not yet reached the point where th
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