Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
OtherPractice

Cognitive screening of older patients

Frank Molnar and Chris Frank
Canadian Family Physician January 2020, 66 (1) 40;
Frank Molnar
Geriatric specialist in Ottawa, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Chris Frank
Family physician in Kingston, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

Clinical question

Who should I assess for cognitive impairment and what screening tools should I use?

Bottom line

The Canadian Task Force on Preventive Health Care

recommend[s] not screening asymptomatic adults 65 years of age or older for cognitive impairment. (Strong recommendation, low-quality evidence) .... The recommendation does not apply to [patients with] symptoms suggestive of cognitive impairment ... or who are suspected of having cognitive impairment by clinicians, family or friends.1

But if family and friends do not report cognitive impairment (because they do not notice it or incorrectly label it “normal aging”), what signs should alert clinicians to its subtler forms? Once suspected, what screening tools should clinicians employ? This is especially pertinent given changes in access to the Montreal Cognitive Assessment (MoCA).

The Mini-Mental State Examination used to be most commonly used until the rights owners began to charge for use. Many FPs then began using MoCA. Recently, one of the MoCA developers announced he will be charging for training, certification, and access to the full website resources. What other tools have been validated in primary care?

Evidence

Six reasonably brief cognitive screening tests have been validated in primary care: Mini-Cog, Memory Impairment Screen, General Practitioner Assessment of Cognition, Short Portable Mental Status Questionnaire, Free and Cued Selective Reminding Test, and 6 Item Cognitive Impairment Test.2–9 To learn more visit www.dementiascreen.ca.

Approach

Patients do not always come to you with cognitive concerns (in fact, patients might lose awareness of their impairment). Some caregivers incorrectly dismiss cognitive changes as “normal aging” and do not raise the issue. Paying attention to subtler signs (Box 1) might flag those needing screening.

When patients or families raise concerns, do not assume it is normal aging; always consider formal assessment. Guidelines can help guide the overall approach to initial assessment (www.cfp.ca/content/60/5/433), which should include cognitive screening, medication review, and investigations for remediable factors.10

Box 1.

Behavioural flags suggestive of dementia

  • Frequent calls to the office or visits to the doctor or emergency department

  • Poor historian, vague, seems “off,” repetitive

  • New nonadherence with medications or instructions (loss of ability to manage concurrent medical conditions that they could manage in the past)

  • Changes in appearance, mood, personality, behaviour

  • Word-finding problems, decreased social interaction

  • Missing appointments, coming on the wrong day

  • Confusion: postoperative delirium or with illness or new medications

  • Weight loss in the older person living alone

  • Driving: accidents, problems, tickets, family concerns

  • Head-turning sign (turning to caregiver for answers)

Developed by Dr W. Dalziel and printed with permission.

Implementation

Use a screening tool in addition to reviewing functional effects of deficits, with corroboration from family if possible. No cutoff score on any test definitively diagnoses dementia; your knowledge of the patient and their function is key. Screening score is relevant but one of many factors. How the patient approaches tasks—which they do well; what is challenging—provides useful information particularly compared with past ability. As decline progresses, repeat testing with the same tool might provide objective information.

Notes

Geriatric Gems are produced in association with the Canadian Geriatrics Society Journal of CME, a free peer-reviewed journal published by the Canadian Geriatrics Society (www.geriatricsjournal.ca). The articles summarize evidence from review articles published in the Canadian Geriatrics Society Journal of CME and offer practical approaches for family physicians caring for elderly patients.

Footnotes

  • Competing interests

    None declared

  • This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro link.

  • La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro de janvier 2020 à la page e12.

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Canadian Task Force on Preventive Health Care,
    2. Pottie K,
    3. Rahal R,
    4. Jaramillo A,
    5. Birtwhistle R,
    6. Thombs BD,
    7. et al
    . Recommendations on screening for cognitive impairment in older adults. CMAJ 2016;188(1):37-46.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Lorentz WJ,
    2. Scanlan JM,
    3. Borson S
    . Brief screening tests for dementia. Can J Psychiatry 2002;47(8):723-33.
    OpenUrlCrossRefPubMed
  3. 3.
    1. Brodaty H,
    2. Low LF,
    3. Gibson L,
    4. Burns K
    . What is the best dementia screening instrument for general practitioners to use? Am J Geriatr Psychiatry 2006;14(5):391-9.
    OpenUrlCrossRefPubMed
  4. 4.
    1. Milne A,
    2. Culverwell A,
    3. Guss R,
    4. Tuppen J,
    5. Whelton R
    . Screening for dementia in primary care: a review of the use, efficacy and quality of measures. Int Psychogeriat 2008;20(5):911-26.
    OpenUrl
  5. 5.
    1. Ismail Z,
    2. Rajji TK,
    3. Shulman KI
    . Brief cognitive screening instruments: an update. Int J Geriatr Psychiatry 2010;25(2):111-20.
    OpenUrlCrossRefPubMed
  6. 6.
    1. Lin JS,
    2. O’Connor E,
    3. Rossom RC,
    4. Perdue LA,
    5. Eckstrom E
    . Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013;159(9):601-12. Erratum in: Ann Intern Med 2014;160(1):72.
    OpenUrlPubMed
  7. 7.
    1. Yokomizo JE,
    2. Simon SS,
    3. Machado de Campos Bottino C
    . Cognitive screening for dementia in primary care: a systematic review. Int Psychogeriatr 2014;26(11):1783-804. Epub 2014 Jul 15.
    OpenUrlCrossRefPubMed
  8. 8.
    1. Tsoi KKF,
    2. Chan JYC,
    3. Hirai HW,
    4. Wong SYS,
    5. Kwok TCY
    . Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Internal Med 2015;175(9):1450-8.
    OpenUrl
  9. 9.↵
    1. Abd Razak MA,
    2. Ahmad NA,
    3. Chan YY,
    4. Mohamad Kasim N,
    5. Yusof M,
    6. Abdul Ghani MKA,
    7. et al
    . Validity of screening tools for dementia and mild cognitive impairment among the elderly in primary health care: a systematic review. Public Health 2019;169:84-92. Epub 2019 Mar 1.
    OpenUrl
  10. 10.↵
    1. Moore A,
    2. Patterson C,
    3. Lee L,
    4. Vedel I,
    5. Bergman H
    . Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. Recommendations for family physicians. Can Fam Physician 2014;60:433-8. (Eng), e244–50 (Fr).
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Canadian Family Physician: 66 (1)
Canadian Family Physician
Vol. 66, Issue 1
1 Jan 2020
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Cognitive screening of older patients
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Cognitive screening of older patients
Frank Molnar, Chris Frank
Canadian Family Physician Jan 2020, 66 (1) 40;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Cognitive screening of older patients
Frank Molnar, Chris Frank
Canadian Family Physician Jan 2020, 66 (1) 40;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Clinical question
    • Bottom line
    • Evidence
    • Approach
    • Implementation
    • Notes
    • Footnotes
    • References
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • Dépistage cognitif chez les patients plus âgés
  • Google Scholar

Cited By...

  • Navigating the controversies of cognitive screening
  • Google Scholar

More in this TOC Section

Practice

  • Is 45 the new 50 in colorectal cancer screening?
  • Approach to diagnosis and management of childhood attention deficit hyperactivity disorder
  • Determining if and how older patients can safely stay at home with additional services
Show more Practice

Geriatric Gems

  • Approach to chronic kidney disease in the elderly
  • Key signs and strategies for recognizing elder abuse
  • Medical assistance in dying and older adults
Show more Geriatric Gems

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2023 by The College of Family Physicians of Canada

Powered by HighWire