Benefits and Harms of Dementia Screening for Family Members of Older Adults

Résumé fourni par la source

Importance: Early detection of Alzheimer disease and related dementias (ADRD) may influence outcomes for both patients and their family members, yet the risks and benefits of screening for family members are not established. Objective: To evaluate the benefits and risks of ADRD screening for family members of older adults screened in primary care (PC). Design, Setting, and Participants: This multisite randomized clinical trial was conducted in 29 PC clinics from October 2018 to September 2023. Dyads of patients aged 65 years and older and a family member were randomized into 1 of 3 groups: screening only, screening plus referral for diagnostic follow-up, and no-screening control. Data were collected at baseline and at 6, 12, 18, and 24 months. Interventions: Cognitive screening was conducted in-person, by telephone, or secure video using the Mini-Cog, the Memory Impairment Screen Telephone version (MIS-T), or the MIS-T with the clock drawing test. Measures: The primary outcome was family member health-related quality of life at 24 months measured using the Short Form Health Survey (SF-36) physical and mental component summary scores. Secondary outcomes included family member depressive and anxiety symptoms, caregiver preparedness, and caregiving self-efficacy, as well as patient health-related quality of life and depressive and anxiety symptoms. Results: A total of 1808 dyads completed baseline assessments. Mean (SD) patient age was 73.7 (5.7) years and 959 (53%) were female. Among family members, 1171 (64.8%) were spouses, 1224 (67.7%) were female, and mean [SD] age was 64.2 [12.9] years. Overall, 62 patients (5.1%) screened positive for cognitive impairment. Among dyads assigned to screen plus, 10 (35.7%) did not pursue diagnostic follow-up. There were no significant differences between the combined screening groups and no-screening group in SF-36 physical (24-month predicted difference, -0.21; 95% CI, -1.26-0.85) or mental (24-month predicted difference, 0.58; 95% CI, -0.18-1.33) component scores. No differences were observed in patient secondary outcomes at 24 months. Discussion: This randomized clinical trial found that ADRD screening in PC was not associated with improvement in family member health-related quality of life, caregiver preparedness, or caregiving self-efficacy. Screening was also not associated with increased family member depression or anxiety. Low rates of positive screening and high rates of refusal for follow-up diagnostic assessment may help explain these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT03300180.

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