Should Older Adults Be Screened for Cognitive Impairment?

Soo Borson, MD


Medscape General Medicine. 2004;6(1):e48 

In This Article

Rapid, Simple Screens for Cognitive Impairment

Cognitive screening tools applicable for routine use in the primary care setting must be brief, easy to administer, acceptable to older persons, have a good balance between sensitivity and specificity, and be relatively unaffected by education, gender, age, and other factors unrelated to dementia.[5] Because the performance of screening instruments varies widely depending on characteristics of the study sample, instruments proposed for general use should be compared in the same sample with well-established screens such as the familiar Mini Mental State Examination (MMSE). The optimal screen should directly test core cognitive processes impaired in dementias, including, at a minimum, short-term memory and executive function. Sensitivity to very mild and preclinical stages of dementia would be a decided bonus. In a recent review,[6] 13 screens were compared for potential usefulness in routine primary care, and 3, each requiring between 2 and 6 minutes to administer, were considered candidates for careful testing in actual clinical application: the Mini-Cog,[5] the Memory Impairment Screen,[7]and the General Practitioner Assessment of Cognition (GPCOG).[8] These tests share the common features of brevity, simplicity, reasonable sensitivity and specificity, acceptability to patients and clinicians, and inclusion of a core cognitive component of dementia. Of the 2 tests for which data have been published comparing them against the standard MMSE, the Mini-Cog and GPCOG were both at least equal to it in accuracy, and the Mini-Cog, considerably briefer, was superior in some population groups, particularly less well educated and ethnic minority patients.