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To the Editor: In their Commentary, Dr Brayne and colleagues¹ contend that there is insufficient evidence to recommend screening for dementia in primary care. However, they acknowledge that the presence of dementia is widely missed by physicians. Professional organizations concerned with the health of older adults have called for diagnostic assessment of dementia when it is suspected.² Screening is a valid approach for determining when there is a reasonable chance that dementia is present and increasing the proportion of cases detected.

The authors summarize the kinds of data needed to address dementia screening as a matter of health policy. However, we believe that they err in their reasoning regarding its potential harms and confuse good clinical practice with questions of policy. Harms they cite, such as fear of losing a driver's license or being disqualified for health insurance, are not harms of screening but of dementia itself. Many patients with . . . [Full Text of this Article]

J. Wesson Ashford, MD, PhD
ashford@stanford.edu
Department of Psychiatry
Stanford University
Stanford, California

Soo Borson, MD
Department of Psychiatry
University of Washington School of Medicine
Seattle

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