What role do cognitive assessments play in the diagnosis and management of Alzheimer's disease in primary care?

In primary care, cognitive assessments play a crucial role in the initial assessment and diagnosis of suspected dementia, including Alzheimer's disease ¹. When dementia is suspected after an initial history taking, primary care professionals should undertake a physical examination, appropriate blood and urine tests to exclude reversible causes of cognitive decline, and use cognitive testing ¹.

For cognitive testing in primary care, validated brief structured cognitive instruments should be used. Examples include the 10-point cognitive screener (10-CS), the 6-item cognitive impairment test (6CIT), the 6-item screener, the Memory Impairment Screen (MIS), the Mini-Cog, and Test Your Memory (TYM) ¹. It is important not to rule out dementia solely based on a normal score from a cognitive instrument ¹. Additionally, when gathering history from someone who knows the person well, structured instruments like the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or the Functional Activities Questionnaire (FAQ) can supplement the assessment ¹.

The primary care assessment, including cognitive testing, helps to determine if a referral to a specialist dementia diagnostic service (such as a memory clinic or community old age psychiatry service) is necessary ¹,². Referral is indicated if reversible causes of cognitive decline (e.g., delirium, depression, sensory impairment, or medication-related cognitive impairment) have been investigated and dementia is still suspected ¹,².

For the management of Alzheimer's disease, primary care's role regarding cognitive assessments is less about ongoing formal testing and more about monitoring. For individuals with mild cognitive impairment, primary care may arrange regular follow-up visits (e.g., annually) to monitor for possible progression of cognitive deficit ². If symptoms deteriorate, referral for specialist assessment and management is advised ². Healthcare professionals, generally, should not rely solely on cognition scores when assessing the severity of Alzheimer's disease and the need for treatment, especially if physical, sensory, or learning disabilities, or communication difficulties could affect the results ¹.