PEARL: The USPSTF has found that screening instruments are adequate to detect cognitive impairment. However, they concluded that there is insufficient evidence to assess the balance of benefits or harms of screening because the current treatments have small and/or short-lived benefits.

Screening for cognitive impairment is a controversial topic.

• The USPSTF published comprehensive recommendations on the topic in 2020 (as an update to an earlier recommendation).
• In brief, there are adequate screening tools to detect cognitive impairment. (In fact, there are almost too many… see below for a curated sample of free resources and where to find more).
• However, because there is not compelling data to say if population-based screening leads to sufficient patient benefit, there is INSUFFICIENT evidence “to assess the balance of benefits and harms of screening for cognitive impairment in older adults.”
• There certainly is a role for cognitive screening on the individual level.

A comprehensive cognitive evaluation is a necessary and time intensive process! 

• In situations where there is a reasonable concern for cognitive impairment, a complete evaluation is necessary because a negative screening test raises concern of a false negative.

In select circumstances, a brief cognitive screen may be helpful in ruling out cognitive impairment. For example:

• An older adult presents with new onset of paranoia, delusions, or hallucinations. A brief cognitive screen can help differentiate between a primary psychiatric condition versus a secondary psychiatry condition due to dementia.
• Family or provider perception of a “difficult” or “noncompliant” patient. A cognitive screen had help determine if there organic cognitive impairments.

Choose a cognitive screen from the table below: