Encyclopedia of Behavioral Medicine

Living Edition
| Editors: Marc Gellman

Screening, Cognitive

  • Richard HoffmanEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-1-4614-6439-6_279-2

Synonyms

Definition

Cognitive screening is a brief, performance-based assessment of one or more domains of neurobehavioral or cognitive functioning. These assessments typically are completed using standardized cognitive screening tests that can be completed at bedside or in the clinic in 20–30 min or less, often accompanied by interview information elicited from family members or other informants who know the examinee well and can comment on their observations about the examinee’s behaviors or changes in their behaviors.

Description

Cognitive screening tests are very commonly used in behavioral medicine, neuropsychology, neuropsychiatry, and primary care medicine. Surveys indicate that cognitive screening instruments are used by over 50% of practitioners in neuropsychiatry and such tests have become a mainstay in the practice of medicine over the course of the last 35 years. Because cognitive screening tests are brief and require a minimum of specialized testing equipment, they can in most cases be administered at bedside, in a busy clinic, or in the emergency department and serve to identify those patients who might benefit from more extensive workups, including neuroimaging, metabolic assays and blood work, or more extensive neuropsychological testing. Cognitive screening tests are used as one central component in the initial differential diagnosis of delirium versus dementia and are perhaps most frequently used in the initial screening for dementias and mild cognitive impairment (MCI), both of which are underdiagnosed in their earliest stages in primary care practice due to the subtlety of their initial presenting symptoms.

Changes in cognitive functioning are frequently seen as a consequence of a number of neurological and general medical diseases, including dementias and degenerative diseases of the cerebral cortex and subcortical regions of the brain. In addition to central nervous system diseases, cognition may also be affected by other systemic diseases, including respiratory, cardiovascular, and renal diseases as well as some infectious diseases, diseases of the liver and pancreas, nutritional deficiencies, metabolic diseases and diabetes, adverse effects of medications, and exposure to toxic substances. Judicious use of cognitive screening instruments can provide evidence to suggest an underlying medical disorder heretofore undiagnosed and may help guide the use of medications and medication dosages, as well as provide information that may prompt the treatment of reversible conditions, such as reversible dementias and pseudodementias.

Cognitive screening tests can help detect deficits associated with disorders that are commonly missed in a standard psychiatric intake interview, especially in emergency room settings, including patients who present with mild disorientation or evidence of possible substance abuse. In addition, many primary psychiatric disorders have significant effects on cognition, such as affective disorders and schizophrenia, and some focal neurological disorders such as focal strokes, neoplasias, and seizure disorders may have combined cognitive and affective sequelae.

Among the most commonly used and well-researched brief cognitive screening tests are the Mini-Mental State Examination (MMSE), the Cognitive Capacities Screening Examination (CCSE), and the Short Portable Mental Status Questionnaire (SPMSQ), but there are numerous cognitive screening tests available to practitioners at the present time, and these are listed in Table 1. Although there is considerable variability in the component sections of the cognitive screening tests listed in Table 1, in general each contains some assessment of orientation (does the patient know who they are, where they are, and know the day and date), attention and concentration, language skills, memory and immediate recall of verbal information, and visuospatial or drawing/copying skills. Most cognitive screening tests are designed to be completed within 10 min or less. The BIMC, the ACE-R, the CASI, the Cognistat, the RBANS, the HSCS, and the CAMCOG-R contain more extensive subtests and may require up to 30 min to complete. The Mattis Dementia Rating Scale requires 20–45 min to complete and provides assessment of attention, initiation perseveration, visuospatial construction, reasoning, and memory.
Table 1

Cognitive screening tests

Brief cognitive screening tests

AB Cognitive Screen (ABCS)

Abbreviated Mental Test Score (AMTS)

Addenbrooke’s Cognitive Examination III (ACE-III)

Animal Fluency Test

Blessed Information-Memory-Concentration Test (BIMC)

Blessed Orientation-Memory-Concentration Test (OMC)

Brief Alzheimer Screen (BAS)

Brief Cognitive Assessment Tool (BCAT)

Brief Cognitive Rating Scale (BCRS)

Brief Interview for Mental Status (BIMS)

Brief Memory and Executive Test (BMET)

Bowles-Langley Technology/Ashford Memory Test

Cambridge Cognitive Examination-Revised (CAMCOG-R)

Clock Drawing Test (CDT)

Cognitive Abilities Screening Instrument (CASI)

Cognitive Assessment Screening Test (CAST)

Cognistat (also known as the Neurobehavioral Cognitive Status Examination or NCSE)

Cognitive Capacity Screening Examination (CCSE)

Cognitive Disorders Examination (Codex)

Cognitive Failures Questionnaire (CFQ)

Cognitive Performance Scale (CPS)

Cognitive Screening Battery for Dementia in the Elderly

Community Screening Interview for Dementia (CSI’D’)

Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI)

Continuous Recognition Test

Dementia Questionnaire (DQ)

DemTect

Double Memory Test

Eurotest

Fototest

Free and Cued Selective Reminding Test/Five Words Test

Fuld Object Memory Evaluation

Galveston Orientation and Amnesia Test (GOAT)

General Practitioner Assessment of Cognition (GPCOG)

Geriatric Evaluation of Mental Status (GEMS)

Hasegawa Dementia Scale-Revised (HDS-R)

High Sensitivity Cognitive Screen (HSCS)

Hopkins Verbal Learning Test (HVLT)

Imon Cognitive Impairment Screening Test (ICIS)

Isaacs’ Set Test of Verbal Fluency

Kingston Standardized Cognitive Assessment

Kokmen Short Test of Mental Status (STMS)

Mattis Dementia Rating Scale (DRS)

Memory and Executive Screening (MES)

Memory Impairment Screen (MIS)

Memory Orientation Screening Test (MOST)

Mental Alteration Test (MAT)

Mental Status Questionnaire (MSQ)

Middlesex Elderly Assessment of Mental State (MEAMS)

Mini-Addenbrooke’s Cognitive Examination (M-ACE)

Mini-Cog

Mini-Mental Status Examination (MMSE)

Mini-Severe Impairment Battery (Mini-SIB)

Modified Mini-Mental Status Examination (3MS)

Modified WORLD Test (WORLD)

Montpellier Screen (Mont)

Montreal Cognitive Assessment (MoCA)

Neurobehavioral Cognitive Status Examination (NCSE)

Philadelphia Brief Assessment of Cognition

Poppelreuter Overlapping Figure

Queen Square Screening Test for Cognitive Deficits

Quick Mild Cognitive Impairment Screen (Qmci)

Quick Test for Cognitive Speed (AQT)

Rapid Dementia Screening Test (RDST)

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)

Revised Mattis Dementia Rating Scale (DRS-2)

Rowland Universal Dementia Assessment Scale (RUDAS)

Saint Louis University Mental Status Examination (SLUMS)

Severe Impairment Battery (SIB)

Seven-Minute Screen (7MS)

Severe MMSE

Short and Sweet Screening Instrument (SASSI)

Short Blessed Test (SBT)

Short Cognitive Battery (B2C)

Short Cognitive Evaluation Battery (SCEB)

Short Memory Questionnaire (SMQ)

Short Portable Mental Status Questionnaire (SPMSQ)

Short Test of Mental Status (STMS)

Six-item Cognitive Impairment Test (6CIT)

Six-Item Screener (SIS)

Sweet 16

Takeda Three Colors Combination Test

TE4D-Cog

Test for the Early Detection of Dementia from Depression (TE4D-Cog)

Test Your Memory Test (TYM)

Three Word Recall (3WR)

Time and Change Test (T&C)

Trail Making Test (TMT)

Tree Drawing Test (TDT; Koch’s Baum Test)

Verbal Fluency Categories (VFC)

Verbal Fluency Animals (VFA)

Visual Association Test

Cognitive screening tests for specialized patient populations

High Sensitivity Cognitive Screen

HIV Dementia Scale

Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)

Mini-Mental Parkinson (MMP)

Informant- or proxy-rated screening instruments

The Alzheimer Disease 8 (AD8)

Blessed Dementia Rating Scale (BDRS)

Deterioration Cognitive Observee (DECO)

Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE)

Quick Dementia Rating Scale (QDRS)

Telephone and mail screening instruments

Dementia Questionnaire

Five-Minute Telephone Version of the Short Blessed Test (SBT)

Minnesota Cognitive Acuity Screen

Structured Telephone Interview for Dementia Assessment (STIDA)

Telephone Interview for Cognitive Status (TICS)

Telephone MMSE (TMMSE)

Since 1988, there have been several cognitive screening tests designed to be administered by phone or telehealth link, often used in epidemiological studies as more extensive follow-up instruments after an initial administration face-to-face of a brief screening instrument such as the MMSE or the SASSI. Six such instruments are listed in Table 1.

Also listed in Table 1 are five-guided interview or informant-based cognitive screening instruments which are designed to document information from family members or caregivers of patients regarding observed cognitive decline, changes in behavior, or – in the case of the Deterioration Cognitive Observee (DECO) instrument – changes in activity level, long-term memory, short-term memory, visuospatial processing, and new skill learning. Although these can be used as stand-alone measures, they are perhaps best used to complement the findings from cognitive screening tests directly administered to the patient in question.

There is now considerable interest in the development of cognitive screening tests for specific at-risk populations, and recent examples include a cognitive screening test designed to assess changes in cognition in Parkinson patients (MMP), two cognitive screening tests designed to detect the early signs of AIDS-related dementia in AIDS patients (the High Sensitivity Cognitive Screen test and the HIV Dementia Scale), and a recently developed test to screen for post-concussion cognitive changes, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT).

With the aging of the population have come an increased interest in cognitive screening in geriatric populations and the increased need to identify early signs of dementia and early signs of mild cognitive impairment, especially as new treatments are developed that are capable of modifying the progression of dementias. In primary care medicine, the standard of practice in the very near future may well include cognitive screening of all patients over the age of 75 in addition to screening of all younger patients when there is a reason to suspect cognitive impairment.

Cross-References

References and Further Reading

  1. Cullen, B., O'Neill, B., Evans, J. J., Coen, R. F., & Lawlor, B. A. (2007). A review of screening tests for cognitive impairment. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 790–799.CrossRefGoogle Scholar
  2. Demakis, G. J., Mercury, M. G., & Sweet, J. J. (2000). Screening for cognitive impairments in primary care settings. In M. E. Maruish (Ed.), Handbook of psychological assessment in primary care settings (pp. 555–582). London: Lawrence Erlbaum.Google Scholar
  3. Larner, A. (Ed.). (2017). Cognitive screening instruments: A practical approach. New York: Springer.Google Scholar
  4. Lonie, J. A., Tierney, K. M., & Ebmeier, K. P. (2009). Screening for mild cognitive impairment: A systematic review. International Journal of Geriatric Psychiatry, 24, 902–915.CrossRefGoogle Scholar
  5. Malloy, P. F., Cummings, J. L., Coffey, C. E., Duffy, J., Fink, M., Lauterbach, E. C., et al. (1997). Cognitive screening instruments in neuropsychiatry: A report of the Committee on Research of the American Neuropsychiatric Association. Journal of Neuropsychiatry and Clinical Neurosciences, 9, 189–197.CrossRefGoogle Scholar
  6. Mitchell, A. J., & Malladi, S. (2010). Screening and case finding tools for the detection of dementia. Part I: Evidence-based meta-analysis of multidomain tests. American Journal of Geriatric Psychiatry, 18, 759–782.CrossRefGoogle Scholar
  7. Mitrushina, M. (2009). Cognitive screening methods. In I. Grant & K. M. Adams (Eds.), Neuropsychological assessment of neuropsychiatric and neuromedical disorders (pp. 101–126). New York: Oxford University Press.Google Scholar
  8. Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40, 922–935.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2018

Authors and Affiliations

  1. 1.Academic Health CenterSchool of Medicine-Duluth Campus University of MinnesotaDuluthUSA

Section editors and affiliations

  • Mustafa al’Absi
    • 1
  1. 1.University of Minnesota Medical SchoolDuluthUSA