Neuropsychological assessment

 

Healthcare professionals should consider using one of the following brief cognitive tests, that have acceptable diagnostic accuracy, to identify people who benefit from referral to secondary care:

  • Rapid direct tests (taking ≤5 minutes to complete): Six-item Screener (SIS), General Practitioner Assessment of Cognition (GPCOG), Clock Drawing Test, Mini-Cog, Memory Impairment Screen (MIS), Six Item Cognitive Impairment Test (6-CIT), and Mini-ACE
  • Extended direct tests (ranging from 10 to 30 minutes to complete): Free-Cog, Montreal Cognitive Assessment (MoCA), Rowland Universal Dementia Assessment Scale (RUDAS), Mini Mental State Examination (MMSE) or Addenbrooke’s Cognitive Examination III (ACE-III)
  • Self-completion questionnaire: The Test Your Memory (TYM)
  • Informant questionnaires (if a suitable informant is available): AD8 or IQCODE
  • Remote cognitive assessment (where required): Telephone Interview for Cognitive Status (TICS), TICS modified, Tele-MMSE and Tele-Free-Cog.

 

 

Factors to be considered by healthcare professionals when selecting a brief cognitive test include:

  • accuracy of the test
  • time taken to complete the test
  • cost to use the test
  • training requirements in use of the test for healthcare professionals
  • ease of use for the person completing the test, considering literacy and language, additional support needs and cultural sensitivity
  • healthcare professional confidence in using the instrument, interpreting findings and feeding back the results to the person who has completed the test.

Please note that the below table may need to be scrolled horizontally or vertically in order to view all information, depending on your device.

Brief cognitive tests considered suitable for use based on acceptable diagnostic accuracy to identify individuals who might benefit from referral to secondary care

 Test Time to complete (minutes) Free of charge to NHS? a Formal specific training required? Person requires written English / literacy skills?
Rapid direct tests
6-CIT22 <5 Yes No  No 
CDT48 <3 Yes  No  No 
GPCOG52, 53, 54 b  2-5 Yes  Minimal  No 
Memory Impairment Screenb (MIS)22 <4 Yes No  Yes 
Mini-ACE22,45 <5 Yes  Yes  No 
Mini-Cog22,44 <3 Yes  Minimal  No 
Six-item Screener (SIS)22,46 1-2 Yes  No  No 
Extended direct tests
Addenbrooke’s Cognitive Examination (ACE)22,45 10-30 Yes  Yesc Yes 
Free-Cog50,51 5-10 Yes  No  Yes 
Mini Mental State
Examination (MMSE)22,42,60		 10-15  No  Yes  Yes 
Montreal Cognitive
Assessment (MoCA)22,29,47		 10-20 Yes (training certification cost)  Training certification required No 

Rowland Universal Dementia Assessment Scale (RUDAS)22,49

10–15

Yes

Minimal

No
Informant questionnaires
AD-822,55 <3 No (permission required)  No  No 
IQCODE22,56,57 5-7 Yes  No  No 
Self-completion (minimal healthcare practitioner supervision)
Test Your Memory (TYM)22 5-10 Yes  No  Yes 
Remote assessment22,58,59
Tele-Free-Cog 15-20 Yes  No  No 
Telephone Interview for Cognitive Status – modified (TICSm) 15–20 Yes No No
Telephone Interview for Cognitive Status (TICS) 10–20  No  Yes  No 
Tele-MMSE 10-15  No  Yes  No 

a ‘Yes’ indicates that tests are available under creative commons licence or offered free of charge for clinical use by the copyright holders or test developers at November 2023.

b The assessment requires an informant interview for full scoring.

c Training available for NHS staff at www.mvls.gla.ac.uk/aceiiitrainer

 

 

The assessment of dementia should take into account a collateral history (eg from family members or carers) and clinical examination (mental state and focussed physical examination), and not be solely reliant on cognitive assessment.

 

 

Differential diagnosis should be considered both in terms of the person’s cognitive deficit and the other possible causes of dementia.

 

 

Neuropsychological assessment should be considered, alongside other diagnostic approaches (as determined by a suitably trained specialist), in the diagnosis of dementia, especially for people in whom dementia is not clinically obvious.