I’m involved in some training for primary care and this post will include links that people coming to the training (and others) might find useful.
‘Helping you to assess cognition: A practical toolkit for clinicians’ was published by the Alzheimer’s Society in 2013. It is a concise, clearly presented document, which gives guidance on assessing cognition in four settings: primary care; memory clinics; acute care; and care homes. It also includes a number of useful assessment tools including the 6-Item cognitive impairment test (6CIT); the Montreal cognitive assessment (MoCA); and the Addenbrookes cognitive examination-III (ACE-III). Link to it here.
Another useful document is ‘Dementia Revealed What Primary Care Needs to Know’. This is a 2014 publication resulting from a partnership between NHS England and Hardwick CCG with the support of the Department of Health and the Royal College of General Practitioners. It’s longer, more detailed, and takes longer to digest but brings a lot of information together, eg it covers treatment and tackles tricky issues including behavioural and psychological symptoms of dementia, driving and safeguarding. You can find it here.
For those who want a hefty read there is always the NICE Dementia Guideline - currently being reviewed and due for publication in 2017.
There is a website full of information about the Montreal cognitive assessment here. The test is available to download in a range of languages alongside the instructions. There is access to normative data and references. The test is freely available for clinical use.
The ACE III can also be downloaded over the internet: link to it here. There is also a mobile form of the ACE III for use by health professionals. Link to it here.
Diagnosis may be difficult when dementia overlaps with delirium and/ or depressive illness. With regard to depression the Geriatric Depression Scale may be a helpful tool and is open access – the original was a 30 item scale but there are several shorter forms. I sometimes use the GDS15 – see this link: and for delirium the Confusion Assessment Method (CAM) may be useful, see this link.
I would like to stress that the diagnosis of dementia is a clinical diagnosis and tools only contribute pieces of the jigsaw that clinicians need to put together in partnership with the patient and their family. The importance of the history, examination, and understanding the person in their own context are all too often underestimated.
Please feel free to add any suggestions or comments about other useful tools.
PS see also the NHS England document published in 2015 called Dementia diagnosis and management A brief pragmatic resource for general practitioners: find it here
and the Clinical Dementia Rating: find it here (under staging).
PPS added Sept 13th 2016: this page lists a number of useful downloads for professionals - see this link and I received a helpful email drawing my attention to a site which links to a lot of information about aids for use in home care of people living with dementia - see this link. Older Mind Matters Ltd doesn't endorse any of these products or any of the sellers, but I include it because it gives ideas of what is available.
Posted on Wed, December 31, 2014
by Susan Mary Benbow