Systematic review of dementia risk screening tools in primary care settings

Introduction: This preregistered (PROSPERO identification 272529) systematic review analyzed the reliability, validity, acceptability, and feasibility of methods to screen and identify primary care patients at increased risk for dementia. Methods: Inclusion criteria were studies of dementia risk screening methods applied or designed for use in primary care or derived or validated with primary care data for use with community-dwelling adults (aged ≥18 years) without dementia/cognitive impairment. Articles were limited to full-text peer-reviewed studies published in English. Searches were conducted from database inception until September 21, 2021/September 22, 2021 (updated on September 4, 2022 and September 16, 2024) in PubMed, MEDLINE, EMBASE, PsycINFO, and COCHRANE with backwards snowballing. Risk of bias was assessed using the Newcastle–Ottawa Scale for nonrandomized studies, the Cochrane risk of bias tool for randomized trials-V2, and the Critical Appraisal Skills Program qualitative checklist. Results: Eleven validated tools and scores were investigated in 34 studies. Participant numbers ranged from 100 to 94,000,000. Tools and scores were used or validated in 1 (6 tools) to 13 studies (1 tool). Most studies were from higher-income countries. Risk of bias was low in most studies. C-statistics were most commonly used (range=0.52–0.86). Tools and scores generally had acceptable prediction but performed poorly in samples differing from the derivation sample. The Cardiovascular Risk Factors, Aging, and Dementia and Lifestyle for Brain Health demonstrated acceptable validity in midlife samples, and the Lifestyle for Brain Health demonstrated acceptable validity in older samples (aged <80 years). Discussion: The Cardiovascular Risk Factors, Aging, and Dementia and Lifestyle for Brain Health are recommended for midlife and older adults aged <80 years, but further research is needed for adults aged ≥80 years and lower-middle income countries.