Cognitive Evaluation
Once early symptoms of cognitive impairment have been identified, tools and resources in this section will assist in furthering your assessment and help determine whether a full diagnostic assessment is needed. It is also important to assess mental health for coexisting depression, anxiety, baseline and current functional status, medications that may affect cognition, and other potential chronic or progressive causes of cognitive changes (such as strokes, traumatic brain injury, underlying learning disorders). General and geriatric-specific mental health assessments are provided.
These resources represent current best practices and clinically relevant information. Work is actively being done to create resources that better account for cultural background, social determinants of health, and other factors that can help prevent cognitive impairment.
Suggested Physician Resources
Alzheimer’s and Related Dementia Resources
This resource from the National Institute on Aging details tools that are designed for detecting early cognitive changes as well as guidelines for diagnosis and management. Professional training and curricula covering Alzheimer’s and related Dementias are provided, as well as details on clinical trials and studies.
Cognitive Assessments
Mini-Cog™
The Mini-Cog is a three-minute instrument for the patient that consists of two components: a three-item recall test for memory and a clock drawing test. This is a free tool and is available in many languages. Training for use of this tool takes about ten minutes.
Rowland Universal Dementia Assessment Scale (RUDAS)
This validated short cognitive screening instrument is designed to reduce the impact of language and cultural differences on the results of screened individuals. This paper tool is helpful for clinics that serve linguistically diverse populations that have varying education levels.
Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment is a quick and easy instrument that can be adapted for use in the clinical setting. It is easy to administer and score, and the results can be interpreted by the health provider with minimal training. Both an app and paper versions are available. A one-hour Training & Certification module supports MoCA’s validity and was designed for busy medical professionals. It is free for specific participants.
AD8 Dementia Screening Interview
This brief 3-minute test was originally designed as an informant screening tool but has also been validated as a direct questionnaire for the patient. The test consists of eight yes-or-no questions about changes in the person’s thinking, memory, and behavior. In combination with the Mini-COG, the AD8 is effective for detecting early cognitive change. No formal training is needed to administer the test. Its use is granted by Washington University for clinical care purposes.
Mental Health and Geriatric Assessments
Geriatric Depression Scale
The Geriatric Depression Scale can be useful for patients who have mild-to-moderate symptoms of dementia. Score one point when the patient answer matches the test answer. A score of greater than five indicates further evaluation.
Patient Health Questionnaire (PHQ-9)
The PHQ-9 can be useful in clinical practice to assess depression severity and its symptoms. More information about PHQ-9 can be found here.
General Anxiety Disorder-7
This tool is a valid screening tool for gauging severity of generalized anxiety symptoms. Both anxiety and depression may affect cognitive assessment scores.
Functional Activities Questionnaire
The Functional Activities Questionnaire calculates the extent of the patient’s ability to engage in instrumental activities of daily living. The questionnaire is useful to assess and monitor functional changes over time. It is answered by the patient, family, or caregiver to indicate the presence of cognitive impairment.