Abstract
Background
Multiple national expert panels have identified early detection of Alzheimer’s disease and related dementias (ADRD) as a national priority. However, the United States Preventive Services Task Force (USPSTF) does not currently support screening for ADRD in primary care given that the risks and benefits are unknown. The USPSTF stresses the need for research examining the impact of ADRD screening on family caregiver outcomes.
Methods
The Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) is a randomized controlled trial that will examine the potential benefits or harms of ADRD screening on family caregivers. It will also compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening. COADS will enroll 1,800 dyads, who will be randomized into three groups (n=600/group): Screening Only group will receive ADRD screening at baseline with disclosure of the screening results and a list of local resources for diagnostic follow-up; Screening Plus, ADRD screening at baseline coupled with disclosure of the screening results, with positive screen participants referred to a dementia collaborative care program for diagnostic evaluation and potential care; and Control, no screening. The COADS trial will measure the family member quality of life (primary outcome) and family member mood, anxiety, preparedness, and self-efficacy (secondary outcomes) at baseline, 6, 12, 18 and 24 months. Additionally, the trial will examine the congruence of depressive and anxiety symptoms between older adults and family members at 6, 12, 18 and 24 months and compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening between the two groups randomized to screening (Screening Only versus Screening Plus).
Discussion
We hypothesize that caregivers in the screening arms will express higher levels of health-related quality of life, lower depressive and anxiety symptoms, and better preparation for caregiving with higher self-efficacy at 24 months. Results from this study will directly inform the National Plan to Address Alzheimer’s Disease, the USPSTF and other organizations regarding ADRD screening and early detection policies.
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