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Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

Preventive Health Care, 2001 update: Screening for cognitive impairment and dementia in the elderly

Prepared by Christopher J.S. Patterson, MD, FRCPC, Professor, Division of Geriatric Medicine, McMaster University, Hamilton, Ontario and David A. Gass, MD, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, with the Canadian Task Force on Preventive Health Care.

These recommendations were finalized by the Task Force in 1999.

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION

Screening of asymptomatic elderly individuals for cognitive impairment.
The Mini Mental State Examination (MMSE) Instrumental activities of Daily Living measurement is estimated to have an average sensitivity of 83% and specificity of 82% to detect dementia.
II-2 <52-55> There is insufficient evidence to recommend for, or against, screening for cognitive impairment in the absence of dementia, (C)

A characteristic of mild cognitive impairment that may be predictive of progression is self reported memory complaint, preferably corroborated by a family member. II-2 <18,26> Memory complaints should be evaluated and the individual followed to assess progression (B)

In a meta-analysis of studies using informant description of an individual’s cognitive decline, the sensitivity and specificity was estimated as 86% and 80% respectively. II-2 <26,47-50> When caregivers or informants describe cognitive decline in an individual, these observations should be taken very seriously: cognitive assessment and careful follow-up are indicated (A)

MANEUVER	EFFECTIVENESS	LEVEL OF EVIDENCE <REF>	RECOMMENDATION
Screening of asymptomatic elderly individuals for cognitive impairment.	The Mini Mental State Examination (MMSE) Instrumental activities of Daily Living measurement is estimated to have an average sensitivity of 83% and specificity of 82% to detect dementia.	II-2 <52-55>	There is insufficient evidence to recommend for, or against, screening for cognitive impairment in the absence of dementia, (C)
	A characteristic of mild cognitive impairment that may be predictive of progression is self reported memory complaint, preferably corroborated by a family member.	II-2 <18,26>	Memory complaints should be evaluated and the individual followed to assess progression (B)
	In a meta-analysis of studies using informant description of an individual’s cognitive decline, the sensitivity and specificity was estimated as 86% and 80% respectively.	II-2 <26,47-50>	When caregivers or informants describe cognitive decline in an individual, these observations should be taken very seriously: cognitive assessment and careful follow-up are indicated (A)