Short Cognitive Tests in the Diagnosis of Dementia
In the UK, the latest Government Directed Enhanced Services (DES) for general practitioners (GPs) aims to reward them for testing for dementia in at-risk groups. The 2013 dementia Commissioning for Quality and Innovation document (CQUIN) offers payments to National Health Service (NHS) hospital trusts for 'case-finding' patients with dementia—this includes a diagnostic assessment. These programmes promote short cognitive tests to identify patients with possible dementia. The DES specifies the use of a short cognitive test validated in general practice—such as the General Practitioner Assessment of Cognition (GPCOG). The CQUIN includes the Mental Test Score (MTS) as part of the assessment. Both initiatives promote very short assessments, probably to improve compliance. There is a danger that misunderstanding of these tests and their role in the diagnosis of cognitive problems may lead to massive over diagnosis or under diagnosis of dementia. The larger risk is that over reliance on short cognitive tests in the diagnostic process will lead to patients with fixed cognitive problems or delirium receiving a diagnosis of dementia; but there is also a major risk that using easy short cognitive tests will fail to recognise patients with mild dementia.
Outline of Formal UK Recommendations
In the UK, the latest Government Directed Enhanced Services (DES) for general practitioners (GPs) aims to reward them for testing for dementia in at-risk groups. The 2013 dementia Commissioning for Quality and Innovation document (CQUIN) offers payments to National Health Service (NHS) hospital trusts for 'case-finding' patients with dementia—this includes a diagnostic assessment. These programmes promote short cognitive tests to identify patients with possible dementia. The DES specifies the use of a short cognitive test validated in general practice—such as the General Practitioner Assessment of Cognition (GPCOG). The CQUIN includes the Mental Test Score (MTS) as part of the assessment. Both initiatives promote very short assessments, probably to improve compliance. There is a danger that misunderstanding of these tests and their role in the diagnosis of cognitive problems may lead to massive over diagnosis or under diagnosis of dementia. The larger risk is that over reliance on short cognitive tests in the diagnostic process will lead to patients with fixed cognitive problems or delirium receiving a diagnosis of dementia; but there is also a major risk that using easy short cognitive tests will fail to recognise patients with mild dementia.
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