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. 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/documents_custom/gpcog(english).pdf
  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. http://medschool.slu.edu/agingsuccessfully/pdfsurveys/slumsexam_05.pdf
  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
    1. http://dementia.ie/images/uploads/site-images/MoCA-Test-English_7_1.pdf
  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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Related Studies

Ontology: Cognition Disorders (C0009241)

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, ニンチショウガイ
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