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



Explore the Mini-Cog© test    

GPCOG=General Practitioner Assessment of Cognition; MCI=mild cognitive impairment; MIS=Memory Impairment Screen.

*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.

Assess cognition in 5 minutes or less 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:

  • 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
  • 2-4 min*
  • Sensitivity=76%; specificity=89%
  • ≤3 indicates possible cognitive impairment§

GPCOG (General Practitioner Assessment of Cognition)1,4:

  • Patient section assesses aspects of orientation, awareness, and memory. Informant section compares patient’s current and previous functioning
  • 2 to 5 minutes (patient); 1 to 3 minutes (informant)*
  • Combined patient/informant: sensitivity=85%; specificity=86%
  • A patient score of <5 alone or a patient score of 5-8 with an informant score of ≤3 indicates possible cognitive impairment

Alternative, widely used tools are also available at your discretion.

If you detect cognitive impairment, it’s time to evaluate the cause6,7

Alzheimer’s disease is one of the most common neurodegenerative diseases—and accounts for 60% to 80% of all forms of dementia8

If cognitive impairment is found, complete a full diagnostic workup to evaluate its cause, or consider whether it’s time to refer your patient to a specialist.6,7

Add biomarker evidence to your diagnostic workup


DISCOVER AVAILABLE TOOLS

GPCOG=General Practitioner Assessment of Cognition; MMSE=Mini Mental State Examination.

*Different times reported. Times may vary.1,5,6
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):1-10. https://alzres.biomedcentral.com/track/pdf/10.1186/s13195-017-0283-5.pdf . Accessed August 12, 2021.
  4. Kansagara D, Freeman M. A systemic 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. 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.
  7. 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.
  8. Erkkinen MG, Kim MO, Geschwind MD. Clinical neurology and epidemiology of the major neurodegenerative diseases. Cold Spring Harb Perspect Biol. 2018;10:a033118.