Identification and assessment of suspected dementia

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-CIT ²²	<5	Yes	No	No
CDT ⁴⁸	<3	Yes	No	No
GPCOG^{52, 53, 54} b	2-5	Yes	Minimal	No
Memory Impairment Screen ^b (MIS)²²	<4	Yes	No	Yes
Mini-ACE^22,45	<5	Yes	Yes	No
Mini-Cog^22,44	<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	Yes^c	Yes
Free-Cog^50,51	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-8^22,55	<3	No (permission required)	No	No
IQCODE^22,56,57	5-7	Yes	No	No
Self-completion (minimal healthcare practitioner supervision)
Test Your Memory (TYM)²²	5-10	Yes	No	Yes
Remote assessment^22,58,59
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.