Caring for a loved one with dementia can be a challenging journey, filled with complex emotions and tough decisions. As families and caregivers, it's crucial to understand the nature of dementia and the various tools available to help assess and manage the condition. This article aims to provide a comprehensive to the seven most common memory tests used to evaluate if a person has dementia. These include the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog), Mini-Mental State Examination (MMSE), General Practitioner Assessment of Cognition (GPCOG), Montreal Cognitive Assessment (MoCA), Self-Administered Gerocognitive Exam (SAGE), Neuropsychological evaluation, and Short Test of Mental Status. Each of these tests offers unique insights into the cognitive abilities of an individual and can be instrumental in the early detection and management of dementia. By understanding these tests, you can better navigate the path of and ensure your loved one receives the best possible support.

Tests that Neurologists May Use to Diagnosis Dementia

Neurologists use a variety of memory and cognition tests to assess a person's cognitive function and determine if they have any type of dementia. These tests can help identify changes in memory, language skills, math skills, visual and spatial skills, and other abilities related to mental functioning. Some of the different tests that a neurologist may perform include:

  • Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog): This 11-part test is more thorough than the MMSE and can be used for people with mild symptoms. It is considered the best brief examination for memory and language skills.
  • Mini-Mental State Examination (MMSE): This is a brief test that assesses cognitive skills in people with suspected deficits. It examines orientation, memory, attention, the ability to name objects, follow verbal and written commands, and copy a complex shape.
  • General Practitioner Assessment of Cognition (GPCOG): A common test used by GPs to check mental abilities, such as memory or thinking. These tests cannot diagnose dementia but may show there are memory difficulties that need further investigation.
  • Montreal Cognitive Assessment (MoCA): Like the MMSE, the MoCA is a quick way to assess cognitive skills. It includes tasks such as drawing a clock, identifying animals, and repeating a list of words.
  • Self-Administered Gerocognitive Exam (SAGE): This is a cognitive test that individuals can take to assess basic orientation, language, reasoning, calculations, visuospatial orientation (clock drawing), problem-solving, and memory.
  • Neuropsychological evaluation: This is a more in-depth test that is usually performed by a trained professional (a neuropsychologist). It takes one to eight hours to complete and provides a detailed and comprehensive assessment of several cognitive functions.
  • Short Test of Mental Status: A brief test often used by health care providers to assess cognitive function, including memory, and thinking skills.

During these tests, the neurologist may examine a person's ability to think, understand, learn, and remember (cognition), memory, motor function (walking), attention span, and how well they concentrate on things. The tests may also include a of the person's medical history and an interview with them or someone close to them to learn more about their symptoms. These tests are not used alone to diagnose dementia but are part of a multilayered testing process that takes many factors into consideration. Brain scans, such as CT or MRI, may also be used to check for changes in the brain, but they cannot diagnose dementia on their own.

Let us dive deeper into each of these tests.

Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog)

The Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) is a widely used test to measure cognition in research and clinical settings, specifically for patients with mild to moderate Alzheimer's disease (AD). It is a more comprehensive and detailed examination than the Mini-Mental State Examination (MMSE), consisting of 11 modalities that evaluate memory, praxis, and language deficiencies.

The ADAS-Cog is administered by a healthcare professional and typically takes 30 to 45 minutes to complete. The test includes a series of tasks and questions that assess various cognitive domains, such as:

  • Word recall: The person is asked to remember and repeat a list of words.
  • Object naming: The person is asked to name objects shown in pictures.
  • Commands: The person is asked to follow simple verbal commands.
  • Word recognition: The person is presented with a list of words, including the previously learned words, and is asked to identify the ones they remember.
  • Constructional praxis: The person is asked to copy a drawing or write a sentence.
  • Ideational praxis: The person is asked to perform a task that requires multiple steps, such as drawing a clock or writing a sentence.
  • Orientation: The person is asked to state the current date, day of the week, month, year, and location.

Each task is scored based on the person's performance, with higher scores indicating more severe cognitive impairment. ADAS-Cog can be used to track changes in cognitive functioning over time and assess the effects of therapeutic agents on cognitive function. However, it is important to note that the ADAS-Cog has limitations in its sensitivity and specificity, especially for patients with mild cognitive decline and psychiatric conditions.

Mini-Mental State Examination (MMSE)

The Mini-Mental State Examination (MMSE) is a cognitive test commonly used as part of the evaluation for possible dementia. It is a simple pen-and-paper test that assesses a person's cognitive function based on a total score of 30. The test consists of a series of questions and tasks that evaluate various aspects of cognitive function, including:

  • Orientation to time and place: The person is asked to state the current date, day of the week, month, year, and location.
  • Registration: The person is asked to remember and repeat a list of three words.
  • Attention and calculation: The person is asked to perform simple calculations or spell a word backward.
  • Recall: The person is asked to remember and repeat the three words from earlier.
  • Language: The person is asked to name objects, follow verbal and written commands, and write a sentence.
  • Visual-spatial skills: The person is asked to copy a simple drawing or intersecting pentagons.

The MMSE is used to screen patients for cognitive impairment, track changes in cognitive functioning over time, and assess the effects of therapeutic agents on cognitive function. However, it is important to note that the MMSE should not be used in isolation to confirm or exclude a diagnosis of dementia, as it has limitations in its sensitivity and specificity, especially for patients with mild cognitive decline and psychiatric conditions. A score below 24 is considered indicative of dementia, but further tests and evaluations are needed to make a definitive diagnosis.

General Practitioner Assessment of Cognition (GPCOG)

The General Practitioner Assessment of Cognition (GPCOG) is a screening tool for cognitive impairment, specifically designed for general practitioners, primary care physicians, and family doctors. It consists of two components: a cognitive assessment conducted with the patient and an informant questionnaire (only considered necessary if the results of the cognitive section are equivocal, i.e., score 5-8 inclusive).

The GPCOG is a brief and efficient test that can be administered quickly, with patient interviews taking less than 4 minutes and informant interviews less than 2 minutes. It is a screening instrument rather than a diagnostic test, and it is extremely sensitive to detect cognitive impairment. However, it may still miss cases (false negatives) or misclassify someone as impaired even though they are not (false positives), depending on the prevalence of cognitive impairment in the given population.

The cognitive assessment section of the GPCOG consists of four items, while the historical informant section has six items. The test has been reported to be reliable and superior to other screening tools, such as the Abbreviated Mental Test (AMT) and the Mini-Mental State Examination (MMSE), in detecting dementia. The GPCOG has a sensitivity of 0.85, a specificity of 0.86, a misclassification rate of 14%, and a positive predictive value of 71.4% when administered in a two-stage method ( followed by informant questions if necessary).

Montreal Cognitive Assessment (MoCA)

The Montreal Cognitive Assessment (MoCA) is a widely used test to detect mild cognitive decline and early signs of dementia]. It is a brief and efficient screening tool for the assessment of cognitive impairment, designed to be administered and graded by a medical professional. The MoCA is not meant to provide a diagnosis on its own but is used as an indicator that more tests may be required.

The MoCA consists of 30 questions that assess multiple aspects of thinking impacted by dementia, including short-term memory, visuospatial capacity, attention, working memory, executive functioning, language, and orientation to time and place. The test takes approximately 10 minutes to administer. Studies have shown that the MoCA is about 94% accurate in identifying dementia, with a score of 25 and under considered at-risk.

Healthcare professionals use the MoCA test to determine whether a person requires further tests or interventions for dementia. However, the test may not differentiate between different types of dementia, and additional assessments, such as brain scans and neurological testing, may be necessary for a definitive diagnosis. Research is ongoing to evaluate the effectiveness of the MoCA test in various settings and populations.

Self-Administered Gerocognitive Exam (SAGE)

The Self-Administered Gerocognitive Exam (SAGE) is a brief, pen-and-paper cognitive assessment tool designed to detect the early signs of Alzheimer's disease and dementia by measuring mental functions such as thinking, memory, and cognition. It was developed by Douglas Scharre, MD, and his team at the Ohio State University Wexner Medical Center.

Here's how the SAGE test works:

  • Administration: The test is self-administered and can be completed in about 15 minutes. There are four forms of the SAGE test, and individuals only need to take one, as they are all interchangeable. The test requires a pen and paper, and the examinee should be informed that there are four pages to complete. Calendars and clocks should not be available during the testing, and the examinee should not answer specific questions, but rather, do the best they can.
  • Scoring: The maximum score on the SAGE test is 22, and a score of 17 and above is considered normal. The test includes both non-scored and scored items. Non-scored items include demographics, insight into memory or thinking problems, family history, motor symptoms, stroke symptoms, depression symptoms, personality changes, and functional abilities. Scored items include orientation (month, date, year), naming (pictures), similarities (abstract or concrete), and short-term memory recall.
  • Interpreting the results: It is important to note that the SAGE test does not diagnose any specific condition, such as Alzheimer's disease or mini-strokes. However, the results can help a doctor know if further evaluation is necessary. A study published in the Journal of Neuropsychiatry and Clinical Neurosciences found that the SAGE test is a reliable instrument for detecting cognitive impairment and compares favorably with the Mini-Mental State Examination (MMSE).

If an individual is concerned about their cognitive functions or if others have noticed changes in their thinking abilities, they may wish to take the SAGE test. However, if someone is experiencing dementia symptoms, it is advisable to speak with a doctor to discuss further testing options.

Neuropsychological Evaluation

A Neuropsychological Evaluation is a comprehensive assessment of an individual's cognitive and emotional functioning, which helps in the diagnosis and management of dementia. Here's how it works:

  • Performed by neuropsychologists: These professionals have specialized knowledge and training to understand how the brain functions and employ neuropsychological evaluations to measure the most sophisticated components of behavior in a quantitative, standardized way.
  • Goals of the evaluation: The evaluation looks at the brain's behavioral output and tells you how cognitive and emotional functioning may be diminished by brain structural abnormalities, what consequences these brain changes have on daily life, and what could potentially be modified through actionable recommendations.
  • Reasons for evaluation: Neuropsychological evaluations may be recommended for various reasons, including clarifying behavior, aiding in diagnosis, helping with disease management, care, and planning, evaluating the efficacy of a therapeutic strategy, evaluating one's capacity to make decisions, or conducting research.
  • Components of the evaluation: The evaluation reviews attention, episodic memory, language, visuospatial functions, and executive abilities such as reasoning and set.
  • Integration with other information: The integration of neuropsychological test findings with other clinical and biomarker information enhances early detection, differential diagnosis, and care planning.
  • Benefits of testing: When Alzheimer's or dementia are discovered earlier, proper treatments can be started right away for maximum effectiveness. A diagnosis also helps families plan for the future and anticipate upcoming challenges. This type of specialized testing is especially helpful in earlier dementia stages when it's more difficult for doctors to figure out the true cause of unusual behavior.

Short Test of Mental Status

The Short Test of Mental Status (STMS) is a brief screening test specifically developed for use in dementia assessment. It covers a broad range of cognitive functions and is intended to be more sensitive to problems of learning and mental agility that may be seen in mild cognitive impairment (MCI) and early dementia. Here's how it is used to diagnose dementia:

  • Administration: The test is usually conducted by a doctor or specialist in their office and takes around 5 minutes to complete. The STMS consists of several tasks, including:
  • Orientation: The patient is asked to state the current date, month, and year, as well as their location.
  • Registration: The patient is asked to remember four words that are read to them.
  • Attention and calculation: The patient is asked to count backward from 20 by twos.
  • Recall: The patient is asked to recall the four words they were asked to remember earlier.
  • Language: The patient is asked to name objects, repeat a sentence, and follow a three-step command.
  • Writing: The patient is asked to write a sentence.
  • Copying: The patient is asked to copy a design.
  • Scoring: The STMS is scored based on the patient's performance in each task, with a total possible score of 30. A score of 29 or less is suggestive of underlying dementia.
  • Sensitivity and specificity: The STMS has been found to have a sensitivity of 86.4% and a specificity of 93.5% in identifying dementia. However, the reliability and validity of the test may vary.
  • Consideration with other tests: The results of the STMS should be considered along with the patient's history, examination, and other cognitive tests to make a comprehensive diagnosis of dementia.

Conclusion

Navigating the journey of dementia can be challenging, but with the right tools and understanding, it is possible to provide the best care for your loved one. The seven memory tests discussed in this article offer valuable insights into the cognitive abilities of an individual and can play a crucial role in the early detection and management of dementia. Remember, these tests are not standalone diagnostic tools but are part of a comprehensive evaluation process that includes medical history, physical examination, and brain scans. It's important to consult with healthcare professionals who can interpret these tests and you through the process. Caregivers, your role is invaluable in supporting your loved one through this journey. By staying informed and proactive, you can help ensure they receive the best possible care and support.

Resources

Cleveland Clinic Cognitive Testing

Standford Medicine Cognitive and Neuropsychological Tests

Mayo Clinic Mild Cognitive Impairment (MCI)

WebMD Neuropsychological Tests

Harvard Health Testing for Dementia

Alzheimer's Association Medical Tests for Alzheimers

Alzheimer's Society Tests and scans used to diagnose dementia

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Calibrating Mini-Mental State Examination Scores to Predict Misdiagnosed Dementia Patients

Mini‐Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI)

Mini-Mental State Exam (MMSE) Alzheimer's / Dementia Test: Administration, Accuracy and Scoring

Alzheimer Disease Assessment Scale

The Alzheimer's Disease Assessment Scale–Cognitive Subscale (ADAS-Cog): Modifications and Responsiveness in Pre-Dementia Populations. A Narrative Review

General Practitioner Assessment of Cognition (GPCOG) Score

Montreal Cognitive Assessment Test (MoCA) for Dementia & Alzheimer's

Montreal Cognitive Assessment: the Montreal Cognitive Assessment (MoCA) is more sensitive to frontotemporal dementia

What to know about the SAGE test for dementia

Self-Administered Gerocognitive Examination (SAGE) Administration and Scoring Instructions

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What is a Neuropsychological Evaluation?

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