Screening Instruments for Cognitive Impairment
The most widely used screening approach in clinical practice is a clinical assessment for orientation, short- and long-term memory as part of the mental state examination.
Screening and brief assessment instruments for cognitive function are available. The most suitable are those that include assessment of frontal lobe (executive) dysfunction such as the Montreal Cognitive Assessment (MOCA) and the Addenbrookes Cognitive Evaluation (ACD, Version III). The Mini-mental State Examination (MMSE) should be avoided as it does not adequately assess frontal lobe functions and can give inflated estimates of cognitive performance. The MMSE is copyright protected.
The Clock Drawing Test (see Appendix) is another widely used screening test for cognitive dysfunction that can be recommended. As with all such tests, it is best to allow a period of abstinence from alcohol to achieve optimal performance, and caution needs to be applied to ensure testing is not conducted while the patient is intoxicated or still undergoing detoxification, or while affected by benzodiazepines or other sedatives. As well, the clinician must be aware of other factors, such as concomitant anxiety or depression, when interpreting tests of cognitive dysfunction.
Caution needs to be applied to ensure that any testing is not conducted while the patient is intoxicated or actively undergoing detoxification.
| Chapter |
Recommendation |
Grade of recommendation |
| 4.17 |
Screening for cognitive dysfunction should be conducted if the health practitioner suspects the patient has cognitive impairment. Referral to a clinical psychologist or neuropsychologist for further testing may be appropriate. The need for formal cognitive assessment is generally reassessed after the patient has achieved several weeks of abstinence. |
GPP |