II. Precautions
- Cognitive Impairment screening and diagnostic tools have poor efficacy in diagnosing Dementia in primary care
- Tools reviewed include Mini-Cog, IQCODE, MoCA and MMSE
- Stewart (2022) Am Fam Physician 105(6): 590-1 [PubMed]
III. Diagnosis: Neurocognitive Disorder (DSM V)
- Severity
- Minor Neurocognitive Disorder
- Neurocognitive deficits are moderate and do not interfere with Instrumental Activities of Daily Living
- Major Neurocognitive Disorder
- Neurocognitive deficits are severe enough to interfere with Instrumental Activities of Daily Living
- Minor Neurocognitive Disorder
- Cognitive decline in at least 1 domain
- Complex attention
- Executive Function
- Language
- Learning and Memory
- Perpetual-Motor
- Social Cognition
- Diagnosis based on both subjective and objective findings
- Concerns of patient, reliable informant or clinician AND
- Neurocognitive testing
- Exclusion criteria
- Not limited to episodes of Delirium
- Not explained by other mental disorder
IV. Diagnosis: Older
- Amnesia (Wexler)
- One of the following (in addition to Amnesia Above)
- Aphasia (communication disorder)
- Apraxia (purposeful Movement Disorder)
- Agnosia (sensory interpretation deficit)
- Executive Function Disturbance (e.g. Serial 7's)
V. Evaluation: Dementia Screening Tools
- See Mental Status Consolidated Screening
-
Mini-Cognitive Assessment Instrument
- Three minute Dementia Screening
- Patient repeats and recalls 3 unrelated words, and draws a clock face with a given time
-
General Practitioner Assessment of Cognition (GPCOG)
- https://www.alz.org/media/documents/gpcog-screening-test-english.pdf
- Part 1 evaluates orientation, memory and clock drawing by the patient
- Six item verbal evaluation that requires only 4 minutes to complete
- Part 2 obtains history from a reliable family member or friend who has known the patient for at least 5 years
- Six items that inquire about patients memory and independent functioning
- Ascertain Dementia 8-Item Informant Questionnaire
- Early Detection and Screen for Dementia (NTG-EDSD)
- https://www.the-ntg.org/ntg-edsd
- Indicated in adults with Down Syndrome or other congenital intellectual disabilities
VI. Evaluation: Dementia Diagnosis Tools
- See Mental Status Exam (lists all tests, history, exam)
- St. Louis University Mental Status (SLUMS)
- https://www.slu.edu/medicine/internal-medicine/geriatric-medicine/aging-successfully/pdfs/slums_form.pdf
- Seven minute test (11 items, 30 points), evaluates for Dementia as well as verbal fluency and abstraction
- Addenbrooke's Cognitive Examination (ACE)
-
Mini-Mental Status Exam (requires payment for use)
- Standard decline 3 points per 6 months
- Error is +/- 3 points
-
Montreal Cognitive Assessment (MoCA)
- https://mocacognition.com/
- Ten minute exam testing 8 cognitive domains
- Psychometric Testing
- Test of higher cognitive functioning
- Logical, abstract, conceptual and verbal reasoning
- Identifies more subtle changes in cognition
- Indications
- Early Dementia
- Depression
- Alcohol Abuse versus Alzheimer's Disease
- Unusual Dementias
- Non-english speaker or patient with less education
- Test of higher cognitive functioning
VII. References
- (2014) DSM-V, APA, Washington D.C.
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| Definition (NCI) | A category of psychiatric disorders which are characterized by a deficit in cognition or memory. |
| Definition (CSP) | disturbances in the mental process related to thinking, reasoning, and judgment. |
| Definition (MSH) | Disturbances in the mental process related to thinking, reasoning, and judgment. |
| Concepts | Mental or Behavioral Dysfunction (T048) |
| MSH | D003072 |
| SnomedCT | 443265004 |
| DSM4 | 294.9 |
| English | Disorder, Cognition, Disorders, Cognition, Cognitive Disorder NOS, cognition disorder, Cognition Disorders, COGNITION DIS, cognitive disorder (diagnosis), cognitive disorder, Cognitive disorder (disorder), Cognitive disorder, Cognition Disorders [Disease/Finding], disease cognitive, cognition disorders, cognitive disorder nos, cognitive diseases, cognitive disorders, cognitive disease, Cognitive disorders, Cognitive Disorder, Cognition disorders, cognitive; disorder, Cognitive disorder NOS |
| Italian | Disturbo cognitivo, Disturbi cognitivi |
| Dutch | cognitieve aandoeningen, cognitief; stoornis, cognitieve aandoening, Cognitieve stoornis, Cognitieve stoornissen |
| German | kognitive Stoerungen, kognitive Stoerung, Kognitive Störungen, Störungen der kognitiven Prozesse, Störungen im Denkprozeß |
| Portuguese | Perturbações cognitivas, Ideias Sobrevalentes, Ideias Superestimadas, Alteração cognitiva, Transtornos Cognitivos |
| Spanish | Alteraciones cognitivas, trastorno cognitivo, trastorno cognitivo (trastorno), Trastornos Cognitivos, Trastorno cognoscitivo, Trastornos del Conocimiento |
| Japanese | 認知障害, ﾆﾝﾁｼｮｳｶﾞｲ |
| Swedish | Kognitiva störningar |
| Czech | kognitivní poruchy, poznání - poruchy, Kognitivní poruchy, Kognitivní porucha |
| Finnish | Kognitiiviset häiriöt |
| Russian | KOGNITIVNYE RASSTROISTVA, POZNAVATEL'NOI SPOSOBNOSTI RASSTROISTVA, SVERKHVKLIUCHENIE, КОГНИТИВНЫЕ РАССТРОЙСТВА, ПОЗНАВАТЕЛЬНОЙ СПОСОБНОСТИ РАССТРОЙСТВА, СВЕРХВКЛЮЧЕНИЕ |
| Croatian | SPOZNAJNI POREMEĆAJI |
| Polish | Zaburzenia funkcji poznawczych |
| Hungarian | Cognitiv zavar, Cognitiv betegségek |
| Norwegian | Kognitive forstyrrelser |
| French | Trouble cognitif, Troubles cognitifs, Troubles de la cognition |
