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cognitive assessment

Scales, interviews, inventories & neuropsycolocigal batteries to screen for & identify specific cognitive impairment. Indications: - baseline standardized cognitive testing is 1st priority in cognitive assessment of elderly [5] - Mini-Mental State Examination - Montreal Cognitive Assessment - mini-Cog * Frailty assessment trumps cognitive assessment in informing elderly of therapeutic decisions [6] Differential diagnosis: - most cognitive testing is language-based - near normal cognitive testing with marked functional impairment in patients with frontotemporal demantia - poor performance on cognitive testing with better than expected functional status in patients with primary progressive aphasia Notes: - simple screening tools - not knowing the year may be the best single predictor of cognitive impairment (odds ratio = 37.2) - not knowing the month predicts cognitive impairment (odds ratio = 3.8) - Mini-Mental State Examination (MMSE), Memory Impairment Screen (MIS), & animal naming assessment misclassify dementia in 1/3 of cases [7] - absence of poor memory as rated by the patient's informant predicts misclassification [7] - naming animals while assessing gait speed discriminates elderly with cognitive impairment from normal elderly, 77% for mild cognitive impairment (MCI), > 99% for dementia [8] - stride length variability while naming animals was the most effective for discriminating between MCI & dementia, 97% [8] - 45% of community-dwelling patients with dementia have had formal cognitive assessment [3] - Affordable Care Act requires a cognitive assessment for Medicare recipients during their annual wellness visit [4]

Related

cognition (intelligence) cognitive performance score (CPS) screening for dementia; screening for cognitive impairment; screening for Alzheimer's disease

Specific

anxiety assessment attention assessment behavioral assessment computerized neurocognitive testing executive function assessment language assessment LASSI-L memory assessment mental status examination (MSE) neuropsychologic testing personality assessment psychiatric examination psychoanalysis screening for anxiety screening for depression (includes depression assessment tools) visuospatial function assessment

General

clinical procedure

References

  1. Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw Hill, New York, 2000, pg 91
  2. O'Keeffe E et al. Orientation to time as a guide to the presence and severity of cognitive impairment in older hospital patients. J Neurol Neurosurg Psychiatry 2011 May; 82:500 PMID: 20852313
  3. Kotagal V et al. Factors associated with cognitive evaluations in the United States. Neurology 2014 Nov 26 PMID: 25428689 http://www.neurology.org/content/early/2014/11/26/WNL.0000000000001096
  4. Centers for Disease Control & Prevention (CDC) Preventing Chronic Disease. Routine Check-Ups and Other Factors Affecting Discussions With a Health Care Provider About Subjective Memory Complaints, Behavioral Risk Factor Surveillance System, 21 States, 2011. CME ACTIVITY - Volume 13 - January 28, 2016 http://www.cdc.gov/pcd/issues/2016/15_0471.htm
  5. NEJM Question of the Week. May 1, 2018 https://knowledgeplus.nejm.org/question-of-week/1613/
  6. Medical Knowledge Self Assessment Program (MKSAP) 18, 19. American College of Physicians, Philadelphia 2018, 2022
  7. Ranson JM, Kuzma E, Hamilton W et al Predictors of dementia misclassification when using brief cognitive assessments. Neurology Clinical Practice. Nov 28, 2018 http://cp.neurology.org/content/early/2018/11/28/CPJ.0000000000000566
  8. Ali P, Renaud P, Montero-Odasso M et al Gait performance in older adults across the cognitive spectrum: Results from the GAIT cohort. J Am Geriatr Soc. 2024 Aug 29. PMID: 39206968 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19162