Cognitive Test Questions For Dementia

Why Do I Need A Cognitive Test

If you show signs of cognitive impairment, your doctor may order or perform a cognitive test. These signs and symptoms may include:

• Becoming more forgetful when it comes to dates and events.
• Losing things more often.
• Struggling to find the right word that you usually know.
• Becoming more forgetful in conversations, movies, and books.
• Increased irritability, mood swings, more anxiety than usual.

Assessing Cognitive Impairment In Older Patients

On this page:

• Points to Remember

As a primary care practitioner, you and your staff are often the first to address a patients complaints or a familys concerns about memory loss or possible dementia. This quick guide provides information about assessing cognitive impairment in older adults.

With this information, you can identify emerging cognitive deficits and possible causes, following up with treatment for what may be a reversible health condition. Or, if Alzheimers disease or another dementia is suspected, you can help patients and their caregivers prepare for the future. Brief, nonproprietary risk assessment and screening tools are available.

Opportunities For Cognitive Screening In General Practice

There are several opportunities in the practice to screen your patients for possible cognitive impairment and dementia. These include:

• The 45+ Health Check

• An opportunity to pick up younger onset dementia in your patients under 65 years of age
• Build in questions about cognitive function, concerns about memory, mood and behaviour
• Look at possible risk factors for dementia
• Can be charged to MBS item #717

• The 75+ Health Check

• An opportunity to pick up possible cognitive impairment and dementia in your patient
• Modify the existing 75+ Health Check and include questions about cognitive function, memory, frailty, dexterity, driving and advanced care planning
• Can be charged to MBS item #705

• The Chronic Disease Management/ Plan

• An opportunity to screen for possible cognitive impairment – in your patients under 65 years of age as well as over 75 years of age- undertake annually or bi-annually
• Can be charged to MBS item #721 , #732 , #723 , #731 and #10997

• Mental Health Treatment Plan

• An opportunity to be mindful of a possible diagnosis of dementia/cognitive impairment when preparing and reviewing a MHTP for your patient
• N.B. Dementia is not classified as a mental health disorder under the Better Access to Mental Health Scheme

For more information:

Please visit the Medicare website

For training and advice on how to ‘build dementia practice in your practice’, please go to this section on online training.

IMPORTANT NOTES:

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Other Scans And Procedures To Diagnose Dementia

Other types of scan, such as a SPECT scan or a PET scan, may be recommended if the result of your MRI or CT scan is uncertain.

However, most people will not need these types of scans.

Both SPECT and PET scans look at how the brain functions, and can pick up abnormalities with the blood flow in the brain.

If a specialist is worried that epilepsy may be causing the dementia symptoms, an EEG may be taken to record the brain’s electrical signals , but this is rare.

Page last reviewed: 3 July 2020 Next review due: 3 July 2023

Clinicians Global Impression Of Change

The Clinicians Global Impression of Change is a comprehensive global measure of detectable change in cognition, function and behaviour, usually requiring separate interviews with patients and carers. It is therefore conceptually attractive for assessing progression, but requires a trained clinician and 1040 min of interview time so may be unsuited to routine clinical practice.

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Mental Ability Tests To Diagnose Dementia

People with symptoms of dementia are given tests to check their mental abilities, such as memory or thinking.

These tests are known as cognitive assessments, and may be done initially by a GP.

There are several different tests. A common one used by GPs is the General Practitioner Assessment of Cognition .

Although these tests cannot diagnose dementia, they may show there are memory difficulties that need further investigation.

Most tests involve a series of pen-and-paper tests and questions, each of which carries a score.

These tests assess a number of different mental abilities, including:

• short- and long-term memory
• language and communication skills
• awareness of time and place

It’s important to remember that test scores may be influenced by a person’s level of education.

For example, someone who cannot read or write very well may have a lower score, but they may not have dementia.

Similarly, someone with a higher level of education may achieve a higher score, but still have dementia.

If You Have A Cognitive Impairment Does This Mean You Have Dementia

There are actually many causes of cognitive impairment, so just because you have a mild or severe cognitive impairment, it does not mean that you have Dementia. Alzheimers Disease is the most common type of Dementia that affects the cognitive parts of the brain. It could be a side effect of a medication you are on, depression, or Dementia.

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Instrumental Activities Of Daily Living

The Instrumental Activities of Daily Living scale takes 5 min for a basically trained interviewer to assess ability in eight complex daily living tasks such as telephone use, shopping, housekeeping and finances. These abilities are more complex than the more basic abilities assessed by the Barthel scale, and therefore more sensitive to the cognitive changes seen in dementia. It is very commonly used in European memory clinics .

Benefits Of Early Detection

A diagnosis may offer relief as it answers the reason behind a persons failing memory, behavior changes, and communication difficulties.

Detecting dementia can help a person and their loved ones plan while they are still able to make decisions about their future care, support, and treatment. This also gives them time to arrange legal and financial matters.

Doctors may also recommend lifestyle changes that prevent or slow down the disease. A formal diagnosis also gives a person access to treatments for symptoms, time to build their care team, and the potential to enroll in clinical trials.

An early diagnosis also helps prepare the persons family. It helps them receive the information, advice, and resources they need to prepare for the challenges as the disease progresses.

• hemoglobin A1C to check for diabetes

They may also run a urinalysis or a cerebrospinal fluid analysis if they suspect an infection. They may also request a toxicology screen involving drug and alcohol tests.

The looks at specific markers in the blood that relate to Alzheimers disease. These markers can identify a persons likelihood of amyloid plaques in the brain. They include beta-amyloid and apolipoprotein E .

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How Accurate Is The Mini

Studies have shown that the Mini-Cog correctly identifies dementia in about three-quarters of the people who are tested. Researchers say that it is not proven effective enough to be used in clinical or doctors-office settings as a screening test for dementia, like the Mini-Mental State Exam . However, this does not mean that it is ineffective for its stated purpose of identifying people who should seek further advice from experts because their memory loss may indicate dementia. As a means of deciding whether you or your loved one should seek further advice from a doctor, the Mini-Cog is useful.

Correlations Between The Fct Scores And Other Neuropsychological Assessments

In these correlational analyses, there was a total of 333 non-demented individuals . Spearmanâs correlation analyses were utilized to examine the relationships between the FCT scores and other neuropsychological assessments . The FCT scores were positively associated with AVLT delay recall , animal fluency , BNT-30 , CFT and SDMT scores. Further, the FCT scores were negatively associated with TMT-A and TMT-B scores.

Correlations between the FCT scores and other cognitive domains. Abbreviation: FCT: Five-minute cognitive test. AVLT: Auditory Verbal Learning Test BNT-30: Boston Naming Test-30 TMT-A: Trail Making Test A TMT-B: Trail Making Test B CFT: Rey-Osterrieth Complex Figure Test SDMT: Symbol Digit Modalities Test.

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Pros And Cons Of The Mmse

Pros: Useful in multiple ways. The MMSE can be used to screen for suspected dementia, so someone who suspects theyre developing the disease might take it it estimates the stage and severity of dementia for someone who has the disease and it can show changes over time if taken every year or so. Easy to administer. No special equipment or training is necessary. Short and simple. The test only takes about 10 minutes to complete.

Cons: Less reliability. An educated person with dementia, for instance, might be able to score above 24. Not sensitive to Mild Cognitive Impairment. MMSE does not do a good job detecting Mild Cognitive Impairment or early dementia. Someone in the beginning stages, in other words, can still achieve a high score. Requires a certain level of education. Someone with a sub-eighth-grade level of education should not take the MMSE, because low educational experience can lead to a misdiagnosis.

DementiaCareCentral.com was developed with funding from the National Institute on Aging . The site is for educational purposes, medical decisions should not be based on its content and its authors assume no liability for errors or omissions. Content cannot be reproduced without permission.©1995-2022.

Abbreviated Mental Test Score

The Abbreviated Mental Test Score assesses the possibility of dementia in elderly patients.

It involves a practitioner asking a person with suspected dementia 10 questions, such as their date of birth, address, and who the current president/monarch/head of state is. The person gets a point for each correct answer.

A score of six and below suggests dementia or delirium.

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Who Should Be Evaluated For Cognitive Impairment

There are several reasons why a doctor may suggest a cognitive test. These may include the following reasons.

• Patients have memory concerns and have other symptoms of cognitive impairments.
• May also include changes in personality, depressions, balance issues, falling more often.

Part of an Annual Wellness visit.

Dementia Severity Rating Scale

The Dementia Severity Rating Scale was developed by Clark & Webank and updated by Webank et al . You can administer this multiple-choice questionnaire to determine whether a person has a mild, moderate, or severe impairment. In addition, it can be used to predict rate of decline over time.

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Dementia & Alzheimer’s Disease

There are a variety of ways doctors can test cognitive function in a person with dementia.

Often, a patient or a family member has picked up on clues that there is a problem with cognition.

However, are there ways to formally and objectively assess this?

The answer is, yes there are a host of cognitive tests for dementia that range from simple bedside tests that take a few minutes to perform to in-depth neuropsychiatric testing that can take a few hours.

While imaging of the brain can provide insights into brain structure and some types of brain imaging can even show metabolic and blood flow function, cognitive tests directly observe performance in certain domains and remain essential in the diagnosis of dementia.

In this article, we will describe what these tests are and how they affect the diagnosis and testing for dementia.

How Is A Cognitive Screening Test Used Alongside A Regular Health Checkup

Your healthcare provider usually asks about your medical and medication history before ordering a cognitive screening test. Theyll order lab work and other tests or scans to rule out other causes of mental decline.

Some treatable or reversible conditions that affect mental functioning include:

• Underactive thyroid gland .

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Demographic And Clinical Information

Initially, there was a total of 360 subjects, including 226 subjects with normal cognition, 107 subjects with MCI and 27 patients with mild AD. However, we found that controls have significantly higher education than subjects with MCI . It is well known that education is a factor that affects the scores of the cognitive assessments. Thus, we applied propensity score matching to minimize confounding biases . Through PSM with ratio of 1 to 1 , a total of 107 healthy controls were selected from the initial 226 healthy controls. The demographic and clinical data of 241 participants were listed in Table 1.

The Mmse Alone Cant Be Used For A Dementia Diagnosis

No matter what they score on the Mini Mental Status Exam, dont consider those results to be the final answer.

Many factors can influence someones MMSE score, both positively and negatively. This is only one of many dementia diagnosis tools.

The MMSE is a useful screening tool, but cant be used to diagnose dementia because there are many factors that could affect the test results.

Complicating factors include:

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Evaluating Cognitive Impairment And Dementia

Screening includes office-based assessments of cognitive function, as well as laboratory testing and neuroimaging. All patients suspected of having dementia should have a physical examination, including a screening neurological examination and review of medications, as a part of the evaluation.

Quick Cognitive Screening Tests

Mini-Mental State Examination

The Mini-Mental State Examination is an 11-item test that takes five to 10 minutes to administer .

• Scoring: suggested cut-off of 24 or less out of 30 should raise concerns about possible dementia.
• Performance affected by age and education
• Test items that are most sensitive to detection: orientation to date , delayed word recall and intersecting pentagons
• Pros: familiar and takes a relatively short time to administer
• Cons: takes longer than other similar tests tests a limited number of cognitive domains often not sensitive to early cognitive change

Mini-Cog

The Mini-Cog is a first-line cognitive screen for primary care, although it has not been evaluated as extensively as the MMSE or the Montreal Cognitive Assessment. The Mini-Cog combines the delayed three-word recall test and the clock-drawing test .

Delayed three-word recall test

Clock-drawing test

This test involves one item, and takes one to two minutes to administer.

When Is Screening Indicated

In its 2020 review and recommendation regarding routine screening for cognitive impairment in adults 65 years old and older, the U.S. Preventive Services Task Force noted that although there is insufficient evidence to recommend for or against screening for cognitive impairment, there may be important reasons to identify cognitive impairment early. Clinicians should remain alert to early signs or symptoms of cognitive impairment and evaluate the individual as appropriate. Tools such as the Dementia Screening Indicator can help guide clinician decisions about when it may be appropriate to screen for cognitive impairment in the primary care setting.

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What Are The Benefits Of Early Detection

There are so many benefits of early detection of mild cognitive Impairment or Dementia. These include but are not limited to:

• Patients receive benefits, treatment options earlier.
• Patients and family members are able to research and understand the diagnosis before symptoms decline.
• More time is available to plan for the future.
• Anxiety levels are lowered because a diagnosis is put in place to understand current symptoms.
• An earlier diagnosis provides more opportunities to participate in clinical trials if you choose.
• You can participate in all advanced planning, including but not limited to transportation, living options, financial and legal matters, etc.
• Get to know your healthcare team and help build a devoted support team of friends and family.
• Established care and support service will make it easier for the family to help manage your diagnosis as symptoms progress over time.

References

Are There Different Cognitive Tests For Testing For Dementia

There are many different cognitive tests that are available.

The most common ones used by doctors are:

• Montreal Cognitive Assessment

Other names for these same tests may include Montreal Cognitive Assessment, MoCA test, Mini-Mental State Exam , and Mini-Cog.

These tests will help measure mental functions by performing simple tasks and simple questions.

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Generic Measures Of Quality Of Life

EuroQol

The EuroQol measure is a short, freely available generic measure of health-related quality of life. It can be simply administered to patients or carers in the form of a very brief self-completed questionnaire. There are two core components to the instrument: a description of the respondents own health using a health state classification system with five dimensions, and a rating on a visual analogue thermometer scale. It takes 2 min to complete. Like many quality of life instruments, carer and proxy ratings diverge widely, many patients with dementia cannot fill out the instrument, and the chief use of EuroQoL in dementia is as a health utility measure for measuring the economic impact of interventions in trials.

Short Form-36

The Short Form-36 and its shorter descendant the SF-12 are examples of generic measures of quality of life which use recall over particular periods of time and are used to estimate health burden in large populations. These instruments have been shown to have high rates of noncompletion among frail older people and especially among those with moderate to severe dementia. They may have limited use for carers of people with dementia, but probably cannot routinely be used in practice with patients.

How To Take / Administer The Mmse

The Mini-Mental State Exam is best administered by a neurologist, or other healthcare professional, in a doctors office-like environment. However, an online version of the MMSE / Folstein Test is relatively simple, only takes about 15 minutes to complete and can be administered by a friend or family member without special training. If you choose to do this, be aware that the results should not be considered definitive.

Should you not wish to administer the MMSE using your phone or computer, there are numerous MMSEs online that can be printed. Again, you do not need special training and these printed options give easy-to-understand instructions. If you want to take or give the test, follow these basic guidelines and then consult a doctor:

Step 1. There are multiple versions online, and they all ask roughly the same questions. The link above contains a good version that is easy to score.

Step 2 Seat your loved one, the person being tested, in a quiet and well-lit room. Ask for attention. Do not set a timer.

Step 4 Give the person as much time as needed. The MMSE generally takes about 10 minutes to complete, but there is no time limit. Do not rush in any way. In fact, be as positive and encouraging as possible.

Step 6 If more than a few questions were answered incorrectly, youll want to take the finished test to a primary care doctor, who will go over it and decide whether a referral to an expert like a neurologist is appropriate.

Scoring the MMSE

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