Baseline Cognitive Screening Tools

Stage 1: Screening Process

•Used when the presence of a condition or specific deficit is unknown

•Screenings tend to be:

• Low cost

• Brief

• Used with individuals who are asymptomatic or deemed at risk

• Lower accuracy than a comprehensive assessment

• Sensitive – resulting in false positives

Stage 2: Comprehensive diagnostic testing

Based on:

• A reported history

• Symptoms

• Signs

• Positive screening results

•Comprehensive diagnostic test characteristics

Characteristics of a screening test

Screenings: 2 possible outcomes:

• Positive

• Negative 

Psychometric Properties

• Sensitivity

• Specificity

• Positive predictive value

• Negative predictive value

Mini Mental State Examination (MMSE)

Purpose: To screen for cognitive impairments and track patient change/progress over time. (30 items)

Ages: 18 years and older

Population: Community-dwelling adults (aged 18 years and older)

Interpretation: Any score greater than or equal to 24 points (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10–18 points) or mild (19–23 points) cognitive impairment.

MMSE: 3 version

Brief

• More clinical situations, use in populations who haven’t been referred to cognitive services

Standard

• Increased difficulty level , complaints of cognitive decline, or reports of cognitive deficits

Expanded version

• sensitive to sub cortical dementia, and aging, added two new task, longer to administer, more sensitive for individuals with higher education

Orientation X 4: Level of consciousness (LOC)

Orientation (AO, A&O, AOx3, AOx4)

 x1: Oriented to Person. The patient knows his or her name and can recognize significant others.

 x2: Oriented to Person and Place. In addition to knowing his or her name, the patient knows where he or she is.

 x3: Oriented to Person, Place, and Time. In addition to knowing his or her name and location, the patient also knows the date, day of the week, and season.

 x4: Oriented to Person, Place, Time, and Situation. In addition to knowing his or her name, location, and time, the patient can explain the situation of why they are at the healthcare facility.

MINI COG

3 items:

• Three word recognition

• Drawing a clock

• Three word recall

The recommended cut score for dementia screening (0-2 = positive; 3-5 = negative).

• More conservative (0-3 positive, 4-5 negative)

• A total score of 3, 4, or 5 indicates lower likelihood of dementia but does not rule out some degree of cognitive impairment