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iv. Screening and assessment for dementia
Aims
The aims of this content focus area are to:
- Present an overview of the screening and assessment processes required
for dementia.
- Facilitate understanding of the importance of an inter-disciplinary
approach to screening and assessment of a person with a cognitive impairment.
Outcomes
By the end of this content focus area, participants will be able to:
- Explain common diagnostic tools used when a person is suspected of having dementia.
- Outline common scales used to test cognitive function.
Screening and assessment for dementia
The screening and assessment of dementia is complex and, as such, is often most
effective when:
- An inter-disciplinary approach guides the use and interpretation of assessment
results—involving input from, for example, neuro-psychologists, geriatricians, social
workers, nurses and occupational therapists.
- A range of techniques and measures are used.
Information that is commonly collected as part of an assessment includes:
- Personal history (e.g., using self-report questionnaires and standardised
interviews).
- Physical health status (e.g., using both a physical examination and laboratory
tests which may identify causes of cognitive decline other than dementia).
- Cognitive, social, emotional, and language functioning (e.g., using standardised
tests and behavioural observation)
(Alzheimer's
Australia, 2006).
Physical health status:
In addition to a general physical examination, a number of radiological tests may be
used in the screening and assessment of dementia. These include standard X-rays and
brain imaging techniques such as Computed Tomography (CT or CAT) scans, Magnetic
Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single-Photon Emission
Computerised Tomography (SPECT)
(Alzheimer's Australia, 2006).
Cognitive and related functioning:
Tools/tests that measure different aspects of cognitive and related functioning may
also be used as part of screening and assessment for dementia. Several of these are
discussed below. (You may find it useful to investigate these and other tests in more
detail depending on your scope of practice and professional focus).
A tool that is often used to screen for cognitive impairment is the Mini-Mental
State Examination (MMSE).
The MMSE is well known across health disciplines having been used for many years. As
such, there is considerable evidence supporting both the validity and reliability of
this tool. However, its diagnostic usefulness relative to more recently developed
tools has been called into question (see
Brodaty, Low, Gibson & Burns, 2006).
Several other tests can also be used to assess different areas of cognitive
function, including, but by no means limited to:
Commonly, people who are suspected of having cognitive impairment undergo a
"battery" (or set) of tests that investigate a range of cognitive and related
abilities (e.g., language, socio-emotional functioning).
It is difficult to recommend a set of screening tools for the recognition of
dementia that would be suitable for all clients in all situations. For example,
in Indigenous communities in Australia, the
KICA
assessment tool has been shown to be useful. However, concerns have been raised
that some of the symbols used in this test are not entirely meaningful or culturally
relevant for older Indigenous people in certain areas of Australia
(Department
of Western Australia Country Health Service Kimberley, 2006). In addition, the
RUDAS
scale (Storey,
Rowland, Confort, & Dickson, 2004) has been shown to be useful in cognitive
screening and assessment of people from CALD (culturally and linguistically diverse)
backgrounds. Finally, the GP-Cog
is a suitable and validated tool for use by General Practitioners (GPs)-however, it is
not well validated for use by other health care professionals
(Brodaty,
Low, Gibson, & Burns, 2006).
Activity 4
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Use the links provided to access information on the tools/tests discussed above.
In particular, when reading about each tool/test consider:
- The strengths and limitations of the tool/test.
- How the person being screened/assessed may respond to the tool/test.
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Final note: Although there are many cognitive tests mentioned in the
literature, it is important to be aware that not all are valid and/or reliable.
All screening and assessment must be conducted by health care practitioners who:
(a) are appropriately trained in the use of the tool/test; (b) apply the principles
of assessment discussed earlier in this module-including the need for impeccable
history taking; and (c) have an appreciation of clinical diagnosis and subsequent
implications for the person being tested.
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