Regenstrief Institute and Indiana University School of Medicine have conducted the first randomized controlled trial to evaluate the pros and cons of population screening for dementia. The Indiana-based research team discovered that no actual harm, as measured by patient reported depressive and anxiety symptoms, from screening for Alzheimer’s disease and related dementia in diverse rural, suburban and urban primary care clinics in Indiana. This trial didn’t identify any benefit from screening in reducing emergency department visits and hospitalization or increasing advance care planning—however, it is considered a breakthrough in evidencing that screening programs don’t harm the patient.
There is a perception among the population that public screening for dementia could trigger or influence forms of depression or anxiety in patients. Dementia affects more than 5 million people in the United States alone and is frequently unrecognized and underdiagnosed in primary care settings, where most adults receive their health care. The researcher’s shared in their press release that an estimated 50% of primary care physicians are unaware of their older patients’ cognitive status.
The Indiana-based group enrolled more than 4,000 primary care patients age 65 and up in the randomized, controlled Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (CHOICE) trial. Two-thirds of study participants were female; two-third of study participants were white. Called Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) trial examining the impact of dementia screening of older adults on their family member caregivers, the study is led by Dr. Nicole Fowler.
The Study Findings: A Breakthrough
According to the study’s principal investigator the study results are “groundbreaking” as they “scientifically negated the concern that dementia screening may be harmful.” Moreover, Dr. Boustani noted that moving forward the previous obstacles and barriers to dementia screening won’t be in the way of innovative screening programs. Dementia screening offers the patient, their family and the physician/care provider the ability to be proactive; to act such as enter advance care planning.
While 70 percent of study participants who screened positive for cognitive impairment declined a follow up diagnostic assessment, those who did complete a follow up and then received collaborative care had significantly decreased hospital admissions as compared with study participants who were not screened but later developed cognitive impairment. Previous studies led by IU School of Medicine and Regenstrief research scientists have found that the collaborative dementia care model decreased behavioral and psychological symptoms in patients living with dementia and reduced healthcare utilization, resulting in annual cost savings ranging from $908 to $2,856 per patient.
The study noted that “the finding of statistical equivalence of screening on patients’ symptoms of depression and anxiety” is important given that previous studies measuring the public’s perceived attitude of dementia screening reported that patients were concerned that this screening would make them feel depressed or anxious. In fact, it did not.
This study was funded by National Institute on Aging grant R01AG040220.
An important topic even when screening is in place, Dr. Fowler noted, “For a number of reasons, including the lack of drugs to treat dementia and the stigma around the condition, people are hesitant to engage in the next steps of the process after screening,” said Dr. Fowler. “The health care system needs to help bridge this gap and encourage people to follow up on the results of screening tests as they would for any other condition.”
About IU School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.
About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its researchers are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.
Malaz Boustani, MD, MPH, research scientist Regenstrief Institute, founding director of the Center for Health Innovation and Implementation Science; Richard M. Fairbanks Chair in Aging Research at Indiana University School of Medicine; founding director chief innovation and implementation officer, Sandra Eskenazi Center for Brain Care Innovation
Nicole Fowler, PhD, MHSA, research scientist Regenstrief Institute, associate director of the Center for Aging Research; assistant professor Indiana University School of Medicine, implementation scientist at the Center for Health Innovation and Implementation Science
Greg Sachs, MD research scientist Regenstrief Institute; professor of medicine and division chief of General Internal Medicine and Geriatrics, Indiana University School of Medicine