Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Cognitive Decline

In mild cognitive impairment (MCI), the changes in cognition exceeds the normal, expected changes related to age.

The amnestic form is distinguished from the nonamnestic form. The amnestic form often precedes Alzheimer disease (Anderson H.S., 2014)

Signs and symptoms

The term MCI describes a set of symptoms, rather than a specific disease.

A person with MCI has mild problems with one or more of the following:

  • memory - for example, forgetting recent events or repeating the same question

    • Working memory - Holding and manipulating information in the mind, as when reorganizing a short list of words into alphabetical order (Luo L, 2008)

    • verbal and visuospatial working speed, memory, and learning, with visuospatial cognition more affected by aging than verbal cognition (Jenkins L, 2000)

    • Episodic memory – Personal events and experiences (Luo L, 2008)

    • Processing speed (Head D, 2008)

    • Prospective memory – The ability to remember to perform an action in the future (eg, remembering to fulfill an appointment or take a medication (Luo L, 2008)

    • Ability to remember new text information, to make inferences about new text information, to access prior knowledge in long-term memory, and to integrate prior knowledge with new text information (Hannon B, 2009)

    • Recollection (Parks CM, 2010)

  • reasoning, planning or problem-solving - for example, struggling with thinking things through

  • attention - for example, being very easily distracted

  • language - for example, taking much longer than usual to find the right word for something

  • visual depth perception - for example, struggling to interpret an object in three dimensions, judge distances or navigate stairs.

 

A person with MCI may also experience:

  • Depression

  • Irritability and aggression

  • Anxiety

  • Apathy

 

Epidemiology

The prevalence of mild cognitive impairment increases with age.

The prevalence is 10% in those aged 70-79 years and 25% in those aged 80-89 years (Roberts RO, 2008)

Many studies indicate that the risk of Alzheimer disease (AD) is significantly higher in women than in men.

 

Diagnosis

Although no single feature of the general physical examination characterizes MCI, the following should be included in the overall assessment of the patient:

  • Evaluation of mental status

  • Examination for the presence of potential causative comorbid conditions

  • Examination for the presence of sensory and/or motor deficits as potential causes or exacerbating factors

 

No specific diagnostic studies exist for mild cognitive impairment.

However, most clinicians perform a basic workup at minimum to exclude potential treatable causes (eg, thyroid disease, cobalamin deficiency).

 

Research is ongoing in the search for biologic markers that may help differentiate between the large number of conditions that may progress from MCI to full dementia.

Brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT) is often performed in patients with MCI. In general, MRI is preferred, as whole brain and hippocampal volume on MRI can predict progression from MCI to Alzheimer disease (AD) (Risacher SL, 2009).

Three Objects Recall Test

Quick screening test for short term memory

10 min.

Clock Drawing Test

Quick screening test for cognitive dysfunction secondary to dementia, delirium, or a range of neurological and psychiatric illnesses

x min. variable

Cognitive Decline is one of 4 sub-domains of the

Psychological Assessment

The Psychological Assessment is one of 8 domains of the

Comprehensive Geriatric Assessment (CGA)

Psychological Assessment
Psychological Assessment
Psychological Assessment

Back To : Comprehensive Geriatric Assessment

Comprehensive Geriatric Assessment
Comprehensive Geriatric Assessment
Comprehensive Geriatric Assessment

Back To : Psychological Assessment

Standardised Mini Mental State Examination

Cognitive screening instrument to identify people with a moderate to severe level of cognitive impairment

Montreal Cognitive Assessment

Rapid screening instrument for mild cognitive dysfunction.

10 min.

10 min.

Three Objects Recall Test

Three Objects Recall
Three Objects Recall
Three Objects Recall

9 KB

Clock Drawing Test

Clock Drawing Test
Clock Drawing Test
Clock Drawing Test

22 KB

SMMSE

SMMSE
SMMSE
SMMSE

MoCA

MoCA
MoCA
MoCA
Read More about Cognitive Decline
Read More about Cognitive Decline
Read More about Cognitive Decline

* No one tool is recognized as the best brief assessment to determine if a full dementia evaluation is needed.

Some providers repeat patient assessment with an alternate tool (eg, MoCA or sMMSE) to confirm initial findings before referral or initiation of full dementia evaluation.

 

Because few MCI patients have undergone baseline neuropsychological testing before the onset of the impairment, the clinician will have to determine whether a particular score represents a significant change from a patient’s presumed baseline.

Such determinations are inexact, and serial testing eventually will be needed to establish whether the patient’s cognitive function is improving, staying stable, or progressing to full-blown clinical dementia.

AWV = Annual Wellness Visit

GPCOG = General Practitioner Assessment of Cognition

HRA = Health Risk Assessment

sMMSE = Standardised Mini Mental Status Exam

MoCA = Montreal Cognitive Assessment

GPCOG

MoCA
MoCA
MoCA

198 KB

General Practitioner Assessment of Cognition

GP screening for dementia

10 min.

Algorithm for assessment of cognition :

adapted from Alzheimer’s Association Medicare Annual Wellness Visit Algorithm for Assessment of Cognition