What are the recommended screening tools for assessing cognitive impairment in older adults?

When cognitive impairment is suspected in older adults, it should be confirmed using a standardised and validated cognitive impairment measure NICE CG103. However, the guidelines do not specify particular general screening tools for this purpose NICE CG103.

For people with learning disabilities, an assessment of dementia may be supplemented with measures of symptoms such as the Dementia Questionnaire for People with Learning Disabilities (DLD), the Down Syndrome Dementia Scale (DSDS), or the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) NICE NG54. Measures of cognitive function, such as the Test for Severe Impairment (TSI), can be used to monitor changes over time in this group NICE NG54.

People who have had a stroke should be screened for cognitive deficits, and routine screening should use standardized measures NICE CKS. All individuals with clinically evident stroke or transient ischaemic attack (TIA) should be considered at risk for vascular cognitive impairment and considered for screening NICE CKS.

It is important to note that single tools, such as the Mini-Mental State Examination (MMSE), are not designed to assess mental capacity and should not be used as the basis for assessing capacity, although they may provide relevant information NICE NG108.

In specialist dementia diagnostic services, if it is unclear whether a person has cognitive impairment, whether it is caused by dementia, or what the correct subtype diagnosis is, neuropsychological testing may be considered NICE NG97. If Alzheimer's disease is suspected, a test of verbal episodic memory should be included in the assessment NICE NG97. Before suspecting dementia, reversible causes of cognitive decline, including delirium, depression, sensory impairment, or cognitive impairment from medicines, should be investigated NICE CKS.