"Dementia" serves as an umbrella term for several different types of progressive cognitive and functional impairment found in older adults, including Alzheimer's disease, vascular dementia and Parkinson's dementia. Clinicians determine a definitive diagnosis by conducting a neuropsychological and full medical evaluation. Any of several different screening tools may be employed for an initial assessment to determine whether more involved neuropsychological evaluation is warranted.
Mini-Mental Status Exam
The Mini Mental Status Exam, or MMSE, the most studied of all the screening instruments, comprises 20 questions that require about 10 to 15 minutes for administration. The MMSE includes questions about awareness of personal identity, location and time, attention and immediate verbal recall. A clinician can administer it either at bedside in a hospital or in an office or home setting.
Researchers have evaluated the effectiveness of the MMSE in accurately diagnosing dementia. They consider it to have acceptable accuracy, with a fairly low rate of false negative diagnoses but a false positive rate up to 60 percent, according to the Agency for Healthcare Research and Quality. This means that not everyone suspected of having dementia based on the MMSE will actually have it. Therefore, those individuals suspected to have dementia using this test would require more accurate follow-up testing for a definitive diagnosis.
SLUMS
Geriatricians recently developed the Saint Louis University Mental Status Examination, or SLUMS, in an effort to improve upon the MMSE. Many veterans' hospitals use it. Similar in format to the MMSE, it comprises 11 questions that a clinician asks the patient regarding awareness of place and time, short-term memory, verbal comprehension and spatial awareness, according to the Medical School of Saint Louis University website. The SLUMS requires about 10 minutes for administration.
Research studies have suggested that the SLUMS can detect early deterioration in cognition before full dementia develops more accurately than can the MMSE, according to the Science Daily website.
Clock Drawing Test
This simple test evaluates concentration abilities, short-term memory, motor function and executive functioning. The clinician gives the patient a blank piece of paper and asks him to draw an analog clock that reads a particular time, commonly something like "ten minutes after 11," according to the Dr. Peter Braunberger on the Neurosurvival website. The clinician then observes the patient attempt to draw the clock. A normally-functioning patient would quickly draw a circle, the numbers and the positions of the hands in accurate orientation. However, individuals with dementia may be able to draw the circle but positioning the number marks and the hands is often very difficult. They may forget what time was requested or may not be able to figure out how to evenly draw 12 numbers around the circle.
The scores on this simple test often correlate strongly with scores on the MMSE and other screening tools. Across many studies, this test averages a low rate of both false positive and false negative diagnoses, according to the Neurosurvival website.
Other Screening Tools
Numerous other screening tools exist, including the Seven Minute Neurocognitive Screening Battery, the Global Deterioration Scale, the Functional Activities Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly, according to the Agency for Healthcare Research and Quality.
It is generally not recommended for concerned family members to try to administer these tests, as the patient may respond differently to questions posed by a loved one than they do in the neutral atmosphere offered by a clinician.
