Dementia Diagnosis

Aka: Dementia Diagnosis, Dementia Screening, DSM V Neurocognitive Disorder Diagnosis, Major Neurocognitive Disorder, Minor Neurocognitive Disorder, Cognitive Impairment, Cognition Disorder, Neurocognitive Disorder

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II. Precautions

  1. Cognitive Impairment screening and diagnostic tools have poor efficacy in diagnosing Dementia in primary care
    1. Tools reviewed include Mini-Cog, IQCODE, MoCA and MMSE
    2. Stewart (2022) Am Fam Physician 105(6): 590-1 [PubMed]

III. Diagnosis: Neurocognitive Disorder (DSM V)

  1. Severity
    1. Minor Neurocognitive Disorder
      1. Neurocognitive deficits are moderate and do not interfere with Instrumental Activities of Daily Living
    2. Major Neurocognitive Disorder
      1. Neurocognitive deficits are severe enough to interfere with Instrumental Activities of Daily Living
  2. Cognitive decline in at least 1 domain
    1. Complex attention
    2. Executive Function
    3. Language
    4. Learning and Memory
    5. Perpetual-Motor
    6. Social Cognition
  3. Diagnosis based on both subjective and objective findings
    1. Concerns of patient, reliable informant or clinician AND
    2. Neurocognitive testing
      1. See Mental Status Exam
  4. Exclusion criteria
    1. Not limited to episodes of Delirium
    2. Not explained by other mental disorder
      1. See Dementia Differential Diagnosis

IV. Diagnosis: Older

  1. Amnesia (Wexler)
    1. Short Term Memory
    2. Long Term Memory
  2. One of the following (in addition to Amnesia Above)
    1. Aphasia (communication disorder)
    2. Apraxia (purposeful Movement Disorder)
    3. Agnosia (sensory interpretation deficit)
    4. Executive Function Disturbance (e.g. Serial 7's)

V. Evaluation: Dementia Screening Tools

  1. See Mental Status Consolidated Screening
  2. Mini-Cognitive Assessment Instrument
    1. Three minute Dementia Screening
    2. Patient repeats and recalls 3 unrelated words, and draws a clock face with a given time
  3. General Practitioner Assessment of Cognition (GPCOG)
    1. https://www.alz.org/media/documents/gpcog-screening-test-english.pdf
    2. Part 1 evaluates orientation, memory and clock drawing by the patient
      1. Six item verbal evaluation that requires only 4 minutes to complete
    3. Part 2 obtains history from a reliable family member or friend who has known the patient for at least 5 years
      1. Six items that inquire about patients memory and independent functioning
  4. Ascertain Dementia 8-Item Informant Questionnaire
    1. https://www.alz.org/documents_custom/ad8.pdf
  5. Early Detection and Screen for Dementia (NTG-EDSD)
    1. https://www.the-ntg.org/ntg-edsd
    2. Indicated in adults with Down Syndrome or other congenital intellectual disabilities

VI. Evaluation: Dementia Diagnosis Tools

  1. See Mental Status Exam (lists all tests, history, exam)
  2. St. Louis University Mental Status (SLUMS)
    1. https://www.slu.edu/medicine/internal-medicine/geriatric-medicine/aging-successfully/pdfs/slums_form.pdf
    2. Seven minute test (11 items, 30 points), evaluates for Dementia as well as verbal fluency and abstraction
  3. Addenbrooke's Cognitive Examination (ACE)
    1. Differentiates Alzheimer's from other Dementias
    2. Detect early Dementia
  4. Mini-Mental Status Exam (requires payment for use)
    1. Standard decline 3 points per 6 months
    2. Error is +/- 3 points
  5. Montreal Cognitive Assessment (MoCA)
    1. https://mocacognition.com/
    2. Ten minute exam testing 8 cognitive domains
  6. Psychometric Testing
    1. Test of higher cognitive functioning
      1. Logical, abstract, conceptual and verbal reasoning
      2. Identifies more subtle changes in cognition
    2. Indications
      1. Early Dementia
      2. Depression
      3. Alcohol Abuse versus Alzheimer's Disease
      4. Unusual Dementias
      5. Non-english speaker or patient with less education

VII. References

  1. (2014) DSM-V, APA, Washington D.C.

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