Dementia Screening Test: How Clinicians Test For Cognitive Impairment
Many people start to become more concerned about their cognitive health as they approach the age when neurocognitive conditions like Alzheimer’s disease often manifest. If you’re advancing in years, you might be wondering how doctors detect these illnesses and their early warning signs. Are there effective screening and diagnostic tests for dementia?
The short answer is yes: Clinicians have a wide range of screening measures they can use to assess whether a patient is experiencing cognitive symptoms consistent with dementia. Examples include the Montreal Cognitive Assessment, the Ascertain Dementia questionnaire, and the Mini-Mental State Examination. These tools can’t provide a diagnosis, but they can rapidly identify people who may benefit from a more in-depth examination for signs of dementia. Once you have received a diagnosis, it may be helpful to speak with a therapist in order to process any thoughts and feelings that arise.
Dementia, cognitive impairment, and normal aging
Dementia generally refers to a severe type of brain-related illness that’s also known as “major neurocognitive disorder.” A person with dementia usually experiences a pronounced loss of cognitive function due to widespread disruptions in the health and connectivity of their brain cells.
Symptoms usually involve a significant impairment of memory and other mental abilities, such as the following:
- Language use
- Orientation in time and space
- Emotional regulation
- Social cognition
- Planning and execution of simple and complex tasks
- Motor control
In most cases of dementia, this decline in function is progressive, incurable, and irreversible, increasing in severity over time until the individual’s death. Dementia is usually considered distinct from the mild memory problems and absentmindedness that commonly occur in older adults.
MCI vs. dementia
Mild cognitive impairment, or MCI, is another category of functional difficulty that typically falls between normal aging and dementia in terms of severity. Although there’s no firm clinical definition, MCI normally involves persistent or repeated difficulties with mental tasks, such as remembering words, keeping track of possessions, and managing your schedule and activities.
These impairments tend to be more pronounced than those observed in healthy aging, but not yet severe enough to impact a person’s ability to function in daily life. Once a person’s cognitive complaints begin to seriously disrupt their responsibilities, social interactions, or quality of life, it can indicate the onset of dementia.
Not everyone with mild cognitive impairment goes on to develop dementia, and some even return to higher levels of cognitive functioning. That said, research suggests that anyone who’s had MCI is usually at a higher risk of progressing to dementia, although updated evidence may be needed.
Why screen for dementia and cognitive impairment?
Scientists haven’t yet been able to produce a cure for most forms of dementia. The damage these diseases cause to brain cells and the connections between them currently can’t be reversed by any known means.
However, clinical trials have identified some emerging treatments that might have the potential to slow down the loss of brain function in dementia. These therapies may work better during the early stages of the disease, when patients still have most of their cognitive abilities. This approach may require diagnostic methods that can catch dementia early in its progression.
Another potential benefit of early detection is the ability to adopt lifestyle changes that could delay the progression of dementia. Habits like regular exercise and mentally enriching hobbies might build up a “cognitive reserve” that enables people with dementia to retain relatively high levels of function for longer periods.
Finally, identifying neurocognitive diseases earlier might give patients and their family members more time to plan. Saving money for treatment, identifying qualified care providers and facilities, and preparing legal documents, such as advanced care directives, may all improve the quality of life for people with dementia in the long run.
Current screening tests for dementia and MCI
Clinicians and medical researchers have developed a variety of assessment tools meant to evaluate patients for neurocognitive disorders. In general, they’re meant to be used by qualified medical professionals.
Examples of commonly used screening tests for dementia include those discussed below.
Mini-Mental State Examination (MMSE)
The most widely used screening tool for dementia and MCI, the Mini-Mental State Examination, consists of 20 brief tests meant to measure overall cognitive functioning. This assessment can be performed in a relatively short time frame. Although it usually takes longer for individuals who are beginning to experience dementia, they can still typically complete it in around 15 minutes.
While it’s not considered specific enough to be used for diagnostic purposes, the MMSE can help detect cognitive impairment so that an individual can consult with a doctor about their next steps. People who score above a certain threshold can typically be ruled out as potential dementia patients.
Montreal Cognitive Assessment (MoCA)
This single-page test is designed to be administered in 10 minutes or less and is considered a highly sensitive tool for identifying possible cognitive impairment. While its specificity may not be high enough to accurately distinguish between MCI and dementia, it’s frequently used to detect people who may benefit from cognitive care.
Some research suggests that the accuracy of the MoCA may depend in part on the cutoff used to identify someone as cognitively impaired. A 2020 study recommended using two distinct cutoffs, one that rules out healthy individuals and another that definitively identifies MCI. Those who fall between these scores may need further evaluation.
Functional Activities Questionnaire (FAQ)
Used to assess a person’s competence at various everyday tasks, the FAQ is a 10-item questionnaire focused on activities like travel, cooking, managing finances, and keeping track of current events. When completed by someone familiar with the patient, it may be a useful way to identify people who are experiencing cognitive decline.
Ascertain Dementia 8-Item Questionnaire (AD8)
The AD8 is a short screening tool that asks about changes in functioning and thinking that an individual has experienced in recent years — for example, whether they’ve started forgetting the correct month or year, or whether they’ve begun asking the same question repeatedly. Many clinicians value it for its combination of speed, simplicity, and accuracy.
While the AD8 can be completed either by patients or informants (people who know the patient well and interact with them regularly), studies suggest it may be more effective when filled out by informants.
Mini-Cog
Combining a short memory task and a drawing task, the Mini-Cog is another brief assessment tool that may be useful for detecting MCI and dementia. A 2024 review concluded that it’s a highly sensitive and specific test for identifying cognitive impairment in older adults. Some research suggests it may not work as well for patients with lower education levels.
Is there a dementia screening test you can complete at home?
While some people have created dementia screening tests designed for at-home use, organizations like the Alzheimer’s Association often discourage their use. Many of these tests aren’t scientifically validated, and people without medical training may have a hard time interpreting them correctly. This can lead to false positives that cause unnecessary stress or false negatives that prevent people from seeking needed care.
Some at-home tests may help spot early-stage dementia if the results are evaluated by medical professionals. For instance, a 2021 study found that a computerized test called the Self-Administered Gerocognitive Examination (SAGE) could help doctors identify cognitive decline, sometimes earlier than other tests. Patients may complete the assessment every six months and bring the results to their physicians, who can identify potential cognitive impairment based on changes in an individual’s test performance over time.
Laboratory tests for dementia
Research suggests that some lab tests may be able to identify markers of certain kinds of dementia or rule out alternate causes:
- Blood tests: Certain blood tests might be able to detect unusually high levels of biomarkers, such as amyloid beta peptides, a type of protein fragment that seems to play a role in causing Alzheimer’s disease.
- Brain scans: Neuroimaging tools like magnetic resonance imaging (MRI) could help identify structural brain defects associated with dementia, especially when paired with machine learning capabilities.
- Cerebrospinal fluid (CSF) testing: CSF is a fluid found in the brain and spinal cord that usually helps protect and regulate the nervous system. The CSF of patients with diseases like Alzheimer’s may contain biomarkers that can be detected with laboratory testing.
What to do if you receive a positive screening result for dementia
Screening measurements like the MoCA are generally not enough to confirm the presence of MCI or dementia by themselves. If you receive a result that suggests you might be at risk, talking with your primary care physician and a memory care specialist can help you decide on your next steps.
In the meantime, you may be able to help preserve your cognitive health by maintaining nutrient-rich eating habits, exercising regularly, and engaging in leisure activities that challenge and stimulate your brain. Seeing a therapist could also help, since mental health difficulties like depression may be risk factors for dementia.
If you’re unsure how to fit in therapy on top of your other responsibilities and concerns, seeking help online could be a good option. Internet therapy typically allows for a great deal of flexibility in scheduling and eliminates any concerns about transportation to and from appointments.
Research suggests that web-based mental health care can be useful as well as convenient. One paper from 2018 concluded that therapist-guided cognitive-behavioral therapy (CBT) delivered over the internet could be an effective treatment for depressive symptoms.
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