[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 3, October 2011].
This review article examines the cognitive assessment of older people (i.e. those aged over 65 years) with a view to the importance of distinguishing between possible dementia, delirium, and/or depression. Attempting to achieve an accurate cognitive assessment is an essential component for a diagnosis, which can dramatically improve treatment outcomes; yet many older people with dementia, delirium or depression do not receive a diagnosis, or they often receive a misdiagnosis currently.
The character and time frame of cognitive problems are vital considerations when trying to establish an accurate diagnosis and develop a suitable management plan. The accurate and reliable identification of cognitive impairment is best achieved through the integration of three components: (1) observation of the patient, (2) obtaining a collateral account from the main carer, and (3) results from of standardised tests.
The standardised tests of cognitive function considered briefly in this article include the mini-mental state examination, the abbreviated mental test score, and the general practitioner assessment of cognition (GPCOG). The confusion assessment method is another tool, used when screening for delirium.
Every 48 hours spent with delirium is associated with an 11% increase in mortality, so patients showing a rapid onset of cognitive symptoms (or a sudden worsening of established symptoms) should be assessed for delirium urgently. Reliable diagnosis of dementia and depression in older people may take some time, involving regular reviews over several weeks. Improved training is recommended in the diagnosis of dementia, depression, and delirium.
A brief bibliography of the relevant NICE guidelines is included, also indicating some of more important learning / best practice resources.
Full Text Link (Access requires an Athens password or journal subscription).
Young, J. Meagher, D. [and] Maclullich, A. (2011). Cognitive assessment of older people. BMJ (Clinical research ed.), September 7th 2011, Vol. 343(d5042).
Note: Another review article recommended by the authors is shown below:
Woodford, HJ. George, J. (2007). Cognitive assessment in the elderly: a review of clinical methods. QJM: Journal of the Association of Physicians, August 2007, Vol.100(8), pp.469-84.