Standardised Mini-Mental State Examination (SMMSE)
Link
- Access the Standardised Mini-Mental State Examination (SMMSE) guidelines PDF and tool PDF
Type
- Discriminative
- Evaluative
- Screening
Description
- The SMMSE is a standardised version of the “mini mental”.
- It is a widely used screening test for cognitive impairment.
- The test covers a variety of cognitive domains, including orientation to time and place, short and long term memory, registration, recall, constructional ability, language and the ability to understand and follow commands.
Advantages
- Widely used.
- Takes 10 minutes to complete.
- Standardised instructions and scoring have improved reliability.
- Used to determine eligibility for subsidised medication for Alzheimer’s disease.
- Can be used to monitor improvement or deterioration in cognition if performed on a limited basis (e.g. once or twice a year).
Precautions or limitations
- Needs to be done face to face with the patient.
- Needs to be used in conjunction with a collaborative history.
- Scoring should be “interpreted” appropriately in the context of education levels, language barriers or other disabilities (e.g. vision loss).
- In itself it is not a diagnostic tool for cognition disorders but can be suggestive of different syndromes depending on pattern of findings.
Montreal Cognitive Assessment (MoCA) test
Link
- Access the Montreal Cognitive Assessment (MoCA) test
Type
- Screening
- Discriminative
- Evaluative
Description
- The MoCA is a brief cognitive screening tool for cognitive disorders.
Advantages
- One hour online training and certification is available to improve administration, scoring and interpretation.
- Certain versions can be administered over the phone or via a teleconference platform (some reliability and validity testing has occurred for these methods).
- The MoCA app is now available on subscription (this calculates response times).
- Paper test is available in 100 languages and app in 5+.
- Covers more cognitive domains than SMMSE (e.g. frontal lobe testing).
- Can be used to monitor improvement or deterioration in cognition if performed on a limited basis (e.g. once or twice a year).
Precautions or limitations
- Training and certification are mandatory (from 1 April 2021) prior to use of the MoCA test.
- Interpretation of results can only be done by a person with expertise in the cognitive field.
- In itself it is not a diagnostic tool for cognition disorders, but can be suggestive of different syndromes depending on pattern of findings.
- Scoring should be “interpreted” appropriately in the context of education levels, language barriers or other disabilities (e.g. vision loss).
Rowland Universal Dementia Assessment Scale (RUDAS)
Link
- Access the Rowland Universal Dementia Assessment Scale (RUDAS) scoring guide PDF and scoring sheet PDF
Type
- Screening
- Discriminative
- Evaluative
Description
- The RUDAS is a short cognitive screening instrument designed to minimise the effects of educational level, cultural background and language diversity on the assessment of cognitive performance.
Advantages
- Can be utilised with people with limited English language literacy skills.
- Validated in the Australian setting.
- Does not require the presence of an informant.
- Can be used to monitor improvement or deterioration in cognition if performed on a limited basis (e.g. once or twice a year).
Precautions or limitations
- The respondent should respond in the language they are most competent and comfortable with.
- Must be undertaken face to face with the patient.
- Scoring should be “interpreted” appropriately in the context of disabilities (e.g. vision loss).
Addenbrooke’s Cognitive Examination (ACE)
Link
- Access Addenbrooke’s Cognitive Examination (ACE) in PDF format
Type
- Evaluative test for dementias and cognitive impairment
- Discriminative
Description
- The ACE examines the integrity of five cognitive domains (attention and orientation, memory, verbal fluency, language, and visuospatial skills), summed to create a total score out of 100 points. The ACE also contains the MMSE items, so that this score could be generated from the ACE results.
- In its second iteration, the ACE-R expanded the scope of some subtests, and introduced five defined cognitive domain sub scores – an Australian-specific version is available.
- The most recent revision, the ACE-III, was initiated in part to address the copyright issue associated with the MMSE items. As such, the MMSE items, which were part of the ACE-R, were replaced with items with similar face validity and difficulty. Additional improvements included the removal of items that were too culturally specific (“No ifs, ands, or buts”), had low correlations with each other despite putatively loading on the same domain (Serial 7 Subtraction and Spelling WORLD backward), or suffered from ceiling effects (the comprehension items).
Advantages
- A specific version is available for remote administration (requires an informant).
- Sensitive to cognitive changes from mild cognitive impairment to severe dementia.
- Score on the ACE reflects both cognitive and functional ability.
- As a more thorough evaluation of cognition it has more discriminative value in diagnosing causes of cognitive impairment.
Precautions or limitations
- Scoring should be “interpreted” appropriately in the context of education levels, language barriers or other disabilities (e.g. vision loss).
- Needs to be interpreted along with appropriate clinical evaluation (history, examination and investigations) and in isolation does not diagnose underlying cognitive disorders.
4AT rapid clinical test for delirium
Link
- Access the 4AT rapid clinical test for delirium
Type
- Screening
Description
- The 4AT is a short tool for delirium assessment in clinical care.
- It incorporates the Months Backwards test and the Abbreviated Mental Test - 4 (AMT4), which are short tests for cognitive impairment.
- This provides basic cognitive testing, aimed at detecting moderate-severe cognitive impairment, alongside assessment for delirium.
Advantages
- Fast and simple to use.
- All patients can be assessed, even those unable to speak.
- Suitable for use by all practitioners with a basic knowledge of delirium.
- Has built-in cognitive tests.
- Translations are available in 17+ languages.
Precautions or limitations
- Not designed for repeated use through a single day.
- Score of 4+ suggests delirium, but is not diagnostic.
- Score of 1-3 suggests cognitive impairment, but is not diagnostic.
- Requires information from one or more sources.
Geriatric Depression Scale (GDS-S) (15 point version)
Link
Type
- Screening
- Discriminative
- Evaluative
Description
- The GDS-S is a depression assessment tool specifically for older people.
- An original longer form comprising 30 items is also available (GDS-L).
Advantages
- The GDS-S contains 4 brief screening questions that trigger completion of the 15 item version (although it is preferable to complete all 15).
- There are versions in multiple languages.
- Can be completed by questionnaire or by verbal interview.
- Short version is useful for those who fatigue easily or have limited concentration.
- Responses are yes / no.
Precautions or limitations
- Most studies of the GDS have excluded participants with dementia, the reliability and validity in this population is therefore unknown.
- Some items may not reflect the values of some CALD communities.
- Should not be used in isolation to diagnose depression in an older person.