Table 2.
Suggested dementia case-finding evidence requirements
| Proposed criteria | Currently met? |
|---|---|
| The condition | |
| 1. The condition should be an important health problem. | Yes |
| 2. The epidemiology and natural history of the condition, including development from latent to declared disease, should be adequately understood, and there should be a detectable risk factor, disease marker, latent period, or early symptomatic stage. | No |
| 3. All the cost-effective primary prevention interventions should have been implemented as far as practicable. | Difficult to assess |
| The test | |
| 4. There should be a simple, safe, precise, and validated case-finding test. The distribution of test values in the target population should be known and a suitable cutoff level defined and agreed. | Partially met, awaiting clarification of optimal cutoff levels. |
| 5. The test should be acceptable to the population. | No |
| 6. There should be an agreed policy on the further diagnostic investigation of individuals with a positive test result and on the choices available to those individuals. | Yes |
| The treatment | |
| 7. There should be an effective treatment or intervention for patients identified through early detection, with evidence of early treatment leading to better outcomes than late treatment. | No |
| 8. There should be agreed evidence-based policies covering which individuals should be offered treatment and the appropriate treatment to be offered. | Yes |
| 9. Clinical management of the condition and patient outcomes should be optimized in all health-care providers before participation in a case-finding program. | Not possible to assess |
| The case-finding program | |
| 10. There should be evidence from high-quality randomized controlled trials that the case-finding program is effective in reducing mortality or morbidity. | No |
| 11. There should be evidence that the complete case-finding program (test, diagnostic procedures, and treatment/intervention) is clinically, socially, and ethically acceptable to health professionals and the public. | No |
| 12. The benefit from the case-finding program should outweigh the physical and psychological harm (caused by the test, diagnostic procedures, and treatment). | No |
| 13. All other options for managing the condition should have been considered (e.g., improving treatment, providing other services), to ensure that no more cost-effective intervention could be introduced or current interventions increased within the resources available. | No |
| 14. There should be evidence that clinicians can assess the potential benefits of case-finding. | No |