Screening

The ability of screening to significantly change outcomes has not been established.[98]

Studies demonstrate that clinicians and family members under-recognise the early stages of dementia.[99] Although there is no treatment that will halt the progression of AD, it is clinically recommended that older people are screened for the presence of mild cognitive impairment (MCI), as well as overt dementia. When AD is detected early, pharmacological and behavioural strategies can be implemented and planning and safety can be discussed most effectively with the patient and their family.

Target population

All older people who present with memory impairment, decline in functional status, mood disorders, or behavioural abnormalities should be screened. Although there is no consensus on the screening of all older people, many geriatricians screen on the first clinic visit and every few years thereafter in those aged ≥65 years. This is helpful as it establishes a baseline for comparison.

In the US, Medicare recommends a cognitive evaluation, including questioning and observing memory concerns, as part of the annual wellness visit. The American Academy of Neurology recommends annual cognitive health assessment for patients 65 years and older.[100]

Cognitive screening tests

Tools include the Folstein Mini-Mental State Examination (MMSE), the most commonly used screening test (with high sensitivity for detecting dementia, but which often fails to recognise MCI), and the Blessed Dementia Scale.[92] Several other tools are available for bedside screening (e.g., the Saint Louis University Mental Status examination, and Mini-Cog). Saint Louis University School of Medicine: SLUMS Examination Opens in new window Alzheimer's Association: Mini-Cog(TM) Opens in new window

The SLUMS examination has better sensitivity for detecting MCI than the MMSE.[93] The SLUMS examination also accounts for educational background when stratifying cognitive functioning, which will become increasingly important as the sensitivity and specificity of early diagnosis is refined.

Meta-analyses indicate that the Mini-Cog may be a useful cognitive screening tool.[92][94] Alzheimer's Association: Mini-Cog(TM) Opens in new window However, only a limited number of diagnostic studies using Mini‐Cog are available.[92][94] [ Cochrane Clinical Answers logo ]

The Montreal Cognitive Assessment (MoCA) test can be used to detect MCI.[68] Montreal Cognitive Assessment Opens in new window

The clock-drawing task is a commonly used brief assessment that evaluates memory, visuospatial abilities, and executive functioning. There are multiple scoring methods for this test, which may limit the generalisability of results.

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