Clinical Review
Early diagnosis and detection of dementia is becoming increasingly important with our ageing population. Delays in diagnosis of dementia of 8 – 32 months from symptom onset indicate a need for earlier diagnosis. (Brodaty H). Lack of early recognition and management will lead to poor quality care and more costly care.

Barriers to early diagnosis of dementia include time, complexity, and workload within the primary care setting.

Early diagnosis and effective chronic disease management, which includes screening, evaluation and education of patients and their carers’ would reduce health care costs and stress associated with an undiagnosed condition.

Knowledge of what is ahead enables patients to plan for the future while still competent, initiate enduring power of attorney and guardianship, address safety concerns such as driving ability, and enables carers to seek support and education earlier.

GPs are best placed to detect and manage dementia in its early stages. The General Practitioner Assessment of Cognition (CPCOG), Mini-Cog, and Memory Impairment Screen (MIS) are suitable for routine dementia screening in general practice. They are quick and easy to administer while having psychometric properties similar to the Mini Mental State Examination (MMSE). It is recommended that GPs adopt routine screening using the GPCOG, Mini-Cog, or MIS when patients are over 75 years or when cognitive impairment is suspected. (Brodaty H).

Early diagnosis of dementia may empower the patient and carer to take control of their future, access available health care services and take advantage of new treatments as they become available.

Dementia screening tools
The General Practitioner Assessment of Cognition (GPCOG) – This is specifically developed for the use in the primary care setting. The GPCOG consists of both a cognitive test of the patient and an informal interview to increase the predictive power. Both parts can be scored separately, together or sequentially.   

Mini-Cog Assessment Instrument for Dementia – This is a brief screen for cognitive impairment. It takes approximately 3 minutes to administer. It has minimal language content, which reduces cultural and educational bias. The mini-Cog combines a 3-item recall component with a Clock Drawing Test (CDT).

Memory Impairment Screen (MIS) – to improve discrimination in screening for dementia the Memory Impairment Screen is a 4 minute, four item, delayed free and cued test of memory impairment. The MIS uses controlled learning to ensure attention, induce specific semantic processing, and optimize encoding specificity to improve detection of dementia.

Mini-Mental State Examination – one of the most widely used cognitive assessment tests is the Mini-Mental State Examination (MMSE). It is a brief, quantitative measure of cognitive status in adults that assesses all cognitive domains. It can be used to screen for cognitive impairment at a given point in time, to follow the course of cognitive changes in an individual over time, and to document an individual’s response to treatment. The MMSE does have some educational and cultural bias.

For downloadable copies of these tools see the Dementia page.