TARGETING DEMENTIA SCREENING IN PRIMARY CARE SITES

Abstract

With potentially promising therapeutics on the horizon, there is increasing interest in implementing routine dementia screening programs for early detection. Critics have cited since no treatments are currently available, there is no benefit to screening, and that screening itself, may lead to harm. The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of dementia screening (CHOICE) study is currently assessing if routine screening in primary care is associated with benefits or harms. Quality of life, depression, and anxiety are measured at 12 months post screening to determine screening impact. A randomized controlled trial of 4,000 older primary care patients in Indiana. Patients are randomized to receive dementia screening or no dementia screening. Patients are screened with the Memory Impairment Screen (MIS) at baseline either by phone (MIS-T; rural sites) or in person (MIS; urban sites). The positive screen rate varied significantly by site. We performed a logistic regression analysis to determine if patient factors associated with positive screening explained these varying rates. As of December 31, 2015 3,157 patients had been enrolled and 1,585 were randomized to the screening arm. Overall, rates of positive screening tests were 4.6%; lower than the expected and lower than published literature. Results from a logistic regression analysis showed that males (OR=1.97; 95% CI =1.16-1.33), patients age ≥80 years (OR=2.51; 95% CI =1.37-4.59), those with lower education (OR=3.61; 95% CI =1.50-8.70), and who self-reported forgetfulness on the Health Utility Index (OR=4.69; 95% CI =1.51-14.55) had significantly increased odds of screening positive for dementia. Even after adjusting for the demographic differences across recruitment sites, there was a marginally significant difference between sites. Specifically, the two sites where MIS administration was in person had marginally (p=0.096) higher odds (ORs=2.37 and 2.16) of screening positive than the site where administration was by phone. The success of dementia screening programs in primary care will depend on the target population, choice of screening instrument, and mode of administration. These strategies will likely minimize any harm associated with screening (negative and false positive screens) as well as maximize the benefit of detecting early cases.