What cognitive evaluations are used for dementia diagnosis?

From the Guidelines

Cognitive Evaluations for Dementia Diagnosis

The cognitive evaluations for dementia diagnosis typically involve a comprehensive assessment of cognitive function, including memory, language, attention, and executive function.

Screening Tools

The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are commonly used screening tools, with scores below 24 on the MMSE and 26 on the MoCA indicating potential cognitive impairment 1.

• The MMSE is a widely used measure of cognitive function validated in dementia populations, covering six areas: orientation, registration, attention and calculation, recall, language, and ability to copy a figure 1.
• The MoCA is a reliable assessment that includes items that assess attention and executive functions, making it a more valid instrument for dementia trials 1.

Neuropsychological Tests

Additionally, neuropsychological tests such as the Trail Making Test and the Clock Drawing Test may be administered to further evaluate cognitive function 1.

• These tests can provide more detailed information about specific cognitive domains, such as attention, executive function, and visuospatial abilities.

Laboratory Tests

Laboratory tests, including complete blood counts, chemistry panels, and vitamin B12 levels, may be ordered to rule out reversible causes of dementia 1.

• These tests can help identify underlying medical conditions that may be contributing to cognitive impairment.

Other Evaluations

Other evaluations, such as the General Practitioner Assessment of Cognition (GPCOG), Mini Addenbrooke’s Cognitive Exam (M-ACE), and St. Louis University Mental Status (SLUMS), may also be used to assess cognitive function 1.

• These tests can provide additional information about cognitive impairment and help guide diagnosis and treatment.

In summary, a comprehensive cognitive evaluation for dementia diagnosis should include a combination of screening tools, neuropsychological tests, and laboratory tests to provide a thorough assessment of cognitive function.

From the Research

Cognitive Evaluations for Dementia Diagnosis

The following cognitive evaluations are used for dementia diagnosis:

• Mini-Mental State Examination (MMSE) 2, 3, 4, 5, 6
• Montreal Cognitive Assessment (MoCA) 2, 3, 4, 5, 6
• Addenbrooke's Cognitive Examination III (ACE-III) 4
• Mini-Cog test 5
• Addenbrooke's Cognitive Examination-Revised (ACE-R) 5

Characteristics of Each Test

• MMSE:
  • Most commonly used scale in cognitive function evaluation 2
  • Has a sensitivity of 66.34% and specificity of 72.94% for detecting mild cognitive impairment (MCI) 2
  • Has a cutoff point of 27/28 for detecting MCI 2
• MoCA:
  • Superior to MMSE in detecting MCI 2, 3, 6
  • Has a sensitivity of 80.48% and specificity of 81.19% for detecting MCI 2
  • Has a cutoff point of 24/25 for detecting MCI 2
  • Has a cutoff point of 26 for screening in primary care 3
• ACE-III:
  • Most sensitive tool for everyday functioning performance 4
  • Has a cutoff point of 61 for detecting mild and moderate dementia 4
• Mini-Cog test and ACE-R:
  • Have comparable diagnostic performance to MMSE for detecting dementia 5
  • Have a sensitivity of 0.91 and specificity of 0.86 for detecting dementia 5