Should Physicians Screen for Dementia in the Primary Care Setting?

The question of possible benefits of physicians screening for dementia in elderly patients in the outpatient setting remains open. Although no controlled studies have thus far been able to conclusively demonstrate that doing so is in fact beneficial, the end points of such studies, such as mortality, are rather crude. Increasingly, there are arguments that harder to track end points need to be examined in more detail, and that earlier recognition of cognitive impairment can potentially have a significant impact on a number of clinical matters. These include, for example, recognition of potential problems with medication compliance, driving risk, predicting post-operative delirium, and allowing more time for patient and family planning of finances and living arrangements, as well as recommending life style changes in diet and exercise habits that may help retard the progression of early cognitive impairment. In this article we will discuss evidence regarding these points, and also give a brief outline of the pros and cons of some of the numerous brief cognitive screens that can be utilized for screening purposes.