Dementia Screening
Screening tools for dementia are not always ED friendly. For example, the Folstein Mini Mental Status Exam is comprehensive, but cumbersome for ED use.
Several shorter screening tools could be built into a focused ED history and physical.
Use these ED friendly tools for dementia screening:
The Mini-Cog Assessment Instrument
The mini-cog is a 3-item recall test with a clock-drawing test (CDT).
Administration
- Instruct the patient to repeat and then remember 3 unrelated words (Penny Apple Table)
- Give the patient a piece of paper with a circle on it.
- Instruct the patient to place numbers on it to represent the face of a clock. After the patient puts the numbers on the clock face, ask him to draw the hands of the clock to read any specific time, such as ‘ten after eleven’.
- Ask the patient to repeat the 3 previously presented words.
Scoring
1 point for each recalled word after the CDT: Possible Score: 0–3
- 0 indicates positive screen for dementia.
- 1 or 2 with an abnormal CDT indicates positive screen for dementia.
- 1 or 2 with a normal CDT indicates negative screen for dementia.
- 3 indicates negative screen for dementia.
Resources & References
- The Mini-Cog as a Screen for Dementia – Borson, Scanlan et al. JAGS, October 2003, 51 (10) 1451–1454
- Four Sensitive Screening Tools to Detect Cognitive Dysfunction in Geriatric Emergency Department Patients: Brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the Caregiver-completed AD8 – Carpenter, et al Acad Emerg Med; 2011, 18: 374-384
- Watch the video below and answer the questions that follow.
- What score would you give to this and what does it mean?
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- Watch the video below and answer the questions that follow.
- What score would you give to this and what does it mean?
You must be logged in to submit an answer and receive feedback. Please sign in or register to take part.
Important Note
Remember that dementia is common in people over 75. Remember to include SOMETHING in your history and physical to screen for memory impairment.
Discussion: Dementia Screening
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very good and time efficient tool
ok
Identification is possible due to the assessment tools available to you
ggod lecture
Mini-Cog is a wonderful ‘quick and dirty’ screening tool.
k
we should educate everyone on this
But what about people with low education? Common in my setting
okay
..
good assesment tool
good screening tool
very simple and effecttive
ok
quick assessment tool that would be useful in ED
quick helpful tool
reasonable screening tool even in a busy ER,should lead to referral for more in depth evaluation
Good
mini-cog is a quick tool- but a full assessment may be warranted if time allows
good info
ok
good tool to see how the patients mental status is
ok
good tool
great tool if the patient is able to follow any sort of commands and willing to participate. in advance stages they will not follow simple commands and could be worst if there is delirium involved and depression.
agreed
great quick and easy tool. thank you
ok
mini cog all the way
great assessment tool
This was very informative and a great tool to have in the ED.
Great screening tool!
Its agreed
great
good
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good to know
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..
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great tool
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.
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yes
agreed
I love the terms you use
I answered the questions above.
ok
I love this it is so easy.
Good
informative
agree, just unsure of exact score
very good tool
3
OK
Ok
ok
Ok
very useful information.
ok
great
good demo
good tools
x
Informtive
This is a great quick screen for dementia
informative
useful tool
great
Awesome tool, I use this now.
good tool
agree
I couldn’t remember the 3 words, therefore have a score of 0. I clearly have dementia. Can someone fill out my SSI disability paperwork, please?
Great tool. I’ll be asking all of my patients to draw a clock today…should make for an interesting shift!
agree
Quick and easy tool.
great tool
very useful tool!
Agreed
Agreed.
agree
mini-cog is good
good demo
great demo!
such a useful and quick tool to assess a patient for dementia
these are very useful tool to be taught to student nursing to practice as part of head to toe assessment, especially when on clinical experience in long term care setting
true
Great quick test
very useful module
Great tool
Great initial screening tool, it is fast and should be used as it does not take too much time!
yes it is
Mini-Cog screen tool great, easy to use and quick tool.
very useful and quick to administer
Mini-mental exam (MME) excellent tool
Agree with comments
very useful
agree
a comment
very easy and helpful, I will start using this!
easy test we should be doing
A very much underused test in our Emergency department which provides so much information.
easy test to do
Good technique
cool
agree
This is an easy test to administer. I wonder if it will have to change with our technology. Many time devices are now digital, people tend to say 10:15, not a quarter past 10. Some people who are asked to do this test are aware they are not doing it properly and can become frustrated.
simple easy tool to use
helpful
what about a screwed up clock and excellent recall?
Good question! I think that outcome would be a relatively rare situation but possible. The clock draw part of the Mini-Cog is included mostly to identify those people with poor recall at baseline but intact executive function and no agnosia/apraxia i.e. no dementia — given that about 40% of people with NO cognitive impairment can recall only 1 item. I suspect that some post-stroke syndromes (esp. right hemispheric) could have very disturbed spatial recognition and management i.e. “a screwed up clock” but good recall.
such a helpful tool and quick tool that many people can use !
great!
good video
great tool
very helpful
thanks for discussion
Wow. The Mini-Cog is a lot easier to administer than I ever perceived it to be.
THANK YOU FOR EASY DEMO.
easy tool to use
easy to use
.
easy to use
easy and quick test
easy and useful
mini-cog is easy and useful
makes sense
Need to start using mini cog
Quick and easy assessment tool especially useful in the ER setting. Like the Mini cog assessment tool
simple and relatively quick
k
Really like using the mini-cog test; simple and quick
Mini- Cog is an excellent tool to use
easy tool to use
Mini Cog assessment is a simple, easy, quick to perform screening tool which can be easily performed in ED
How would you interpret 3/3 recall with disorganized clock face? An unusual situation, to be sure, but would this be a positive or a negative screen? Or indeterminate — a reason to move on to a more in-depth screening tool probably.
easy test to administer and generally patient’s agree to doing the test
a great tool for ER however we need to remember it is a screen and clients require more work up before definitive diagnosis can be made
This is a very quick and simple tool to use in the ER.
very practical
easy to execute
quick and simple test
useful tool
I find the mini-cog handy in the ED, as it’s quick to administer for a person in whom delirium is not suspected. When a person is unable to see/draw for a variety of reasons (e.g. low vision, pain/paralysis in their hand), I generally ask them to name as many 4-legged animals as they can in 60 seconds.
good option
need to employ this
easy tool
makes sense
very useful, in a few years we need a new test since the world is a digital marvel
quick screening tool
I couldn’t remember the words the first time.
simple test to administer
none
easy to use
EASY ASSESSMENT TOOL
good tool and quick
The mini-cog is a useful, simple and easy to administer test; perfect for the ED.
will screen more often
Quick test
great assessment tool. it can be helpful in the pre-hospital field, should time allow
Mini Cogs in the field…
excellent option
Give it a three and punctuation that does not fail the test
Remember to evaluate memory impairment!
🙂
excellent tool- simple.
This is helpful.
cog is wonderful but can be frustrating for the patient
mini-cog is a quick and easy assessment tool
xx
xx
I like that its a simple test to remember/administer.
3/3
Excellent and practical tool.
Great quick assessment, very realistic for time sensitive assessments.
Excellent
Mini-Cog is a good easy and quick screening tool.
I wouldnt know much about this test before! I would like to know how accurate is this test compared to MMSE?
thanks for the demo!
great demonstration
This is a very simple yet necessary test that can be easily applied by any Health Care practitioner
Mini-Cog is a wonderful ‘quick and dirty’ screening tool.