For assessing suspected cognitive impairment in older adults during a routine general practice consultation, several validated brief structured cognitive instruments are recommended for initial assessment in non-specialist settings NICE NG97. These 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) NICE NG97.
It is important to note that dementia should not be ruled out solely based on a normal score from a cognitive instrument NICE NG97. When cognitive impairment is suspected, it should be confirmed using a standardised and validated cognitive impairment measure NICE CG103. Early detection of cognitive impairment in primary care is crucial for improving care for older adults Fowler et al. 2025.
In addition to cognitive testing, a comprehensive history should be taken from the person with suspected dementia and, if possible, from someone who knows them well, such as a family member NICE NG97. This history should cover cognitive, behavioural, and psychological symptoms, as well as their impact on daily life NICE NG97. Structured instruments like the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or the Functional Activities Questionnaire (FAQ) can supplement the history taken from an informant NICE NG97. Screening for cognitive impairment is a key aspect of managing Alzheimer's disease and related conditions in older adults Rogers et al. 2023.
Before referring to a specialist dementia diagnostic service, reversible causes of cognitive decline, such as delirium, depression, sensory impairment (e.g., sight or hearing loss), or cognitive impairment from medicines associated with increased anticholinergic burden, should be investigated NICE CKS. If indicators of delirium are identified, an assessment using the 4AT tool is recommended NICE CG103. However, single tools like the Mini-Mental State Examination (MMSE) should not be used as the sole basis for assessing mental capacity, although they may provide relevant information NICE NG108. A systematic review has also explored the diagnostic accuracy of various cognitive screening tools validated for older adults Kamalzadeh et al. 2024.
Key References
- CKS - Dementia
- CG103 - Delirium: prevention, diagnosis and management in hospital and long-term care
- NG97 - Dementia: assessment, management and support for people living with dementia and their carers
- NG108 - Decision-making and mental capacity
- CKS - Falls - risk assessment
- (Rogers et al., 2023): Alzheimer Disease and Related Cognitive Impairment in Older Adults: A Narrative Review of Screening, Prevention, and Management for Manual Therapy Providers.
- (Kamalzadeh et al., 2024): Diagnostic accuracy of cognitive screening tools validated for older adults in Iran: a systematic review and meta-analysis.
- (Fowler et al., 2025): Implementing early detection of cognitive impairment in primary care to improve care for older adults.