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Author(s) -
Frank Lori
Publication year - 2007
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2007.03.006
Subject(s) - evidence based medicine , medicine , observational study , randomized controlled trial , evidence based practice , statement (logic) , dementia , best evidence , psychology , intensive care medicine , alternative medicine , political science , disease , pathology , law
The prospect of widespread dementia screening as uggested in our Perspective statement [1] raises a numer of concerns for many clinicians and researchers who ppropriately maintain that evidence in favor of screenng must outweigh evidence against it before it becomes n established practice. Objections to the call for widepread screening, are based on the concern that the “evdence” does not meet standards for recommendation of creening. Certainly evidence in support of dementia creening is a necessity before proceeding with a screenng program. The specific types of evidence requir ot universally agreed upon, however. Even within exsting standards for screening, definitions of key elements urrently vary widely. What constitutes “efficacious reatment”? What are superior “outcomes” for treated atients relative to untreated patients? How should “benfits” and “harms” be characterized and measured? By ome definitions, all of the conditions that would favor creening are currently met. The discussion is now best dvanced by specific review of the available evidence for ach condition with keen attention paid to the varying tandards for evidence acceptance. What evidence is reuired to conform to “evidence-based” standards? It is mportant to acknowledge that “evidence” is too broad a erm and specific levels of evidence, and the criteria used o evaluate them, must be made explicit. This problem ith nonspecific definitions of evidence affects many reas of inquiry beyond screening. For example, while andomized clinical trials (RCTs) are the gold standard or many clinical questions by design there are questions CTs cannot validly address and for which alternate bservational designs are required. There are several ethical issues raised by screening nd their consideration must be included in any weighing f evidence. Some of the same ethical concerns are raised y dementia diagnosis as well, but discussions of screenng are best served by recognizing these overlapping oncerns while maintaining clarity about the differing oals of screening and diagnosis, as we indicate in our erspective statement [1]. Further research and open dis-