Clock hand and inner workings

Clinical Assessment

Brief, objective tools can help you better detect the early signs of cognitive impairment1,2

With new therapies focusing earlier in the disease continuum, assessing cognitive impairment as early as possible is more important than ever.3

Sensitivity of Objective Assessment Tool vs
Subjective Physician Assessment1,2



GPCOG=General Practitioner Assessment of Cognition; MCI=mild cognitive impairment; MIS=Memory Impairment Screen; ns=not significant.

*Compared to subjective physician assessment; in a study evaluating the Mini-Cog© vs physician assessment alone. Other examples of objective assessment tools that take 5 or less minutes to administer include the MIS and the GPCOG.

10 minutes or less is all you need to assess cognition with some commonly used, objective tools1,4,5

The following tests are representative only; alternative tools are available and can be used at the discretion of the clinician.

Mini-Cog©1,4,5

Summary

Composite of 3-word recall and clock drawing; validated in multiple languages in primary care setting; has been found to be more sensitive than MMSE for detecting mild cognitive impairment

Duration

2-4 min*

Sensitivity/Specificity

Sensitivity=76%; specificity=89%

Score

≤3 indicates possible cognitive impairment§

GPCOG1,4

Summary

Patient section assesses aspects of orientation, awareness, and memory. Informant section compares patient’s current and previous functioning

Duration

2 to 5 mins (patient);
1 to 3 mins (informant)*

MoCA6,7

Summary

1-page, 30-point test; assesses 8 cognitive domains through 13 tasks; available in 30 languages; has been found to be more sensitive than MMSE in assessing memory, visuospatial, executive, language function, and orientation to time and place

Duration

10 min

SLUMS8

Summary

30-point, 11-item scale comprising various cognitive assessments; tasks assess attention, numeric calculation, immediate and delayed recall, animal naming, digit span, clock drawing, figure recognition/size differentiation, and immediate recall of facts from a paragraph

Duration

7 min

If you detect cognitive impairment, it’s time to evaluate the cause9,10

60% to 80% of all dementia cases may be attributed to Alzheimer’s disease, one of the most common neurodegenerative diseases.11

If cognitive impairment is detected, it is important to either evaluate the cause via a full diagnostic workup or refer your patient to a specialist.6

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MMSE=Mini-Mental State Examination; MoCA=Montreal Cognitive Assessment; SLUMS=Saint Louis University Mental Status.
*Different times reported. Times may vary.1,5,9
Sensitivity: ability of the test to correctly identify those patients with disease.
Specificity: ability of the test to correctly identify those patients without disease.
§A cutoff point of <3 on the Mini-Cog© has been validated for classifying subjects as “probably impaired,” but many individuals with clinically meaningful cognitive impairment will score higher. When greater sensitivity is desired, a cutoff point of ≤3 is recommended, as it may indicate a need for further evaluation of cognitive status.

References:

  1. Cordell CB, Borson S, Boustani M, et al. Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement. 2013;9(2):141-150.
  2. Borson S, Scanlan JM, Watanabe J, et al. Improving identification of cognitive impairment in primary care. Int J Geriatr Psychiatry. 2006;21(4):349-355.
  3. Aisen PS, Cummings J, Jack CR Jr, et al. On the path to 2025: understanding the Alzheimer's disease continuum. Alzheimers Res Ther. 2017;9(1):60.
  4. Kansagara D, Freeman M. A systematic evidence review of the signs and symptoms of dementia and brief cognitive tests available in VA. Evidence-Based Synthesis Program. 2010. VA-ESP Project #05-225.
  5. Li X, Dai J, Zhao S, et al. Comparison of the value of Mini-Cog and MMSE screening in the rapid identification of Chinese outpatients with mild cognitive impairment. Medicine (Baltimore). 2018;97(22):e10966.
  6. Porsteinsson AP, Isaacson RS, Knox S, Sabbagh MN, Rubino I. Diagnosis of early Alzheimer’s disease: clinical practice in 2021. J Prev Alzheimers Dis. 2021;3(8):371-386.
  7. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699.
  8. Tariq SH, Tumosa N, Chibnall JT, Perry MH, Morley JE. Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder—a pilot study. Am J Geriatr Psychiatry. 2006;14(11):900-910.
  9. Hort J, O'Brien JT, Gainotti G, et al. EFNS guidelines for the diagnosis and management of Alzheimer's disease. Eur J Neurol. 2010;17(10):1236-1248.
  10. Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):270-279.
  11. Erkkinen MG, Kim MO, Geschwind MD. Clinical neurology and epidemiology of the major neurodegenerative diseases. Cold Spring Harb Perspect Biol. 2018;10:a033118.