Cognition

The cognitive state of the patient is assessed under the following categories:

• orientation:
  • time e.g. time of day, day of week, season of year
  • place e.g. "Where are you?"
  • person e.g. "What is your name?"
    
    
• concentration:
  • serial 7's - the patient is asked to repeatedly subtract 7 starting with 100
  • list the months of the year in reverse order
    
    
• memory:
  
  
• short-term:
  • ask the patient to repeat a list of digits
    
    
• new information:
  • give the patient an address to remember
  • ask them to repeat it immediately
  • ask them to repeat it after 3 min of conversation
    
    
• recent events:
  • ask about recent events which are known to you with certainty
    
    
• remote events:
  • ask about dates of wars, Prime Ministers etc.

The Folstein Mini-Mental State Examination (MMSE) is still the most widely used cognitive screening test, but it has been increasingly shown in the literature to be poorly sensitive in differentiating mild cognitive impairment from a dementia syndrome, due largely to the MMSE’s lack of executive function testing. (1) There are several other tests available, including the 10-minute Montreal Cognitive Assessment Scale. (2)

Some instruments, such as the Mini-Cog test and Addenbrooke's Cognitive Examination-Revised (ACE-R), have been shown to perform as well as the MMSE in terms of detecting dementia. (1)

Reference

1. Tsoi KK et al. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015 Sep;175(9):1450-8.
2. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9.