Selection of COGNITIVE SCREENING TOOLS A Peter Sept

Selection of COGNITIVE SCREENING TOOLS A. Peter Sept. 2019

Why Use Cognitive Screening Tools. . . • Objective documentation of cognitive function vs subjective reports • Establish baseline level of functioning; monitor course / progression • Identify strengths & weaknesses in cognitive profile; introduce cognitive adaptive strategies • Identify need for further evaluation / diagnosis – Identify treatable / reversible causes – Possible symptomatic treatment Patient / family planning, behaviour management, identify supports needed, etc

What Tool to Use. . . MMSE SMMSE Mo. CA AMT STMS MIS 3 MS KSCA SLUMS ACE-III Mini-Cog 7 MS SAGE SIS CDT Dozens of available brief MSQ cognitive screening tools Cullen et al, 2007: 39 tests TYM BNA IQCODE VFT SPMSQ TMT RUDAS GPCOG AND MANY MORE!!! 6 CIT Cognistat

Best Known Screens. . . still

MMSE

MMSE Mini Mental State Examination • • • Most widely known / recognized screen Most commonly used for dementia Well established reliability and validity Scores are affected by age, education Not sensitive to MCI Lack of tasks that target higher cognitive domains (eg EF)

MMSE • First published by Folstein et al, 1975, in public domain • Copyright issues: commercially licenced by PAR in 2001 • Can be 'legally' used in 3 ways – Licenced copies purchased from PAR – Original copies authorized by PAR (eg drug company copies) – Administered from memory Stewart et al 2012

SMMSE • MMSE Grey zone? ? ? SMMSE – Standardized Mini-Mental State Exam • Published in 1999 by Molloy and Clarnette • “Developed to provide clear unequivocal guidelines for administration and scoring” of the MMSE, with the support of Folstein • Molloy holds copyright, and has given permission for various jurisdictions to utilize SMMSE

Mo. CA

Mo. CA Montreal Cognitive Assessment • Developed by Nasreddine et al, 1996 / published 2005 • Well recognized and broadly used • Sensitive to MCI • Some controversy regarding original cut-off score • Established reliability and validity • Translated into multiple languages and versions • Rapidly expanding research base • Freely available for clinical use, up to now

Mo. CA What's changed ? • Free access to all versions (test forms and instruction manuals) via website until now • Remains free to use, however access is being restricted • New mandatory training and certification program effective Sept. 1, 2019 & to be completed by Sept. 1, 2020

Mo. CA Training & Certification • 1 hour training video – “administration and scoring tips' – “test analysis of real cases” – “self-test analysis” • $125 US • Certification is valid for 2 years

Mo. CA Certification – Why ? • “to reduce variability and ensure the highest accuracy” • “helps you minimize errors, and thus minimize liability. Fully trained raters are more accurate when administering the test, and less likely to make mistakes that may lead to a misdiagnosis or incorrect treatment. ” • Per 'legal advice'

Mo. CA Certification – my experience. . . • Training video essentially includes same administration and scoring information that is in the instruction manual • Brief information about cognitive domains involved in various assessment tasks • Older video of Nasareddine administering Mo. CA to a cognitively intact individual • A couple of practice scoring examples • Multiple choice test – must pass to get certificate and full access to website

Mo. CA If not certified. . . • No access to forms etc on website (after SE 2020) • “If you wish to continue using the Mo. CA Test without being officially trained and certified, you will be at increased risk for administration, scoring and interpretation errors which could lead to misdiagnosis and liability. ”

SLUMS

SLUMS • St. Louis University Mental Status Examination • Morley & Tumosa, 2002 • “to screen for MNCD and identify dementia or MCI among highly educated patients” • 11 item clinician administered brief cognitive assessment • 7 minute administration • Scored on 30 -point scale

SLUMS • Less commonly known / utilized • More limited psychometric data, but generally found to be valid and reliable • Emerging research on briefer version (RCS) • Freely available to download on St. Louis University site, along with instructions, translations, and additional information • Brief introductory video https: //www. slu. edu

ACE-III

ACE-III • • Addenbrooke's Cognitive Evaluation III First version ACE published 2000 Designed to address limitations of MMSE Several revisions (ACE-R, ACE-III) More extensive evaluation 15+ min. admin, 5 min. scoring Total score out of 100, with 5 domain scores Recent shorter version: M-ACE

ACE-III • Globally well researched, but less commonly known / used in Canada • Good reliability and validity, and good predictive value related to functional outcomes • Freely available from University of Sydney https: //sydney. edu. au • Free ACE-III Trainer through University of Glascow https: //www. mvls. gla. ac. uk/aceiiitrainer/

Mini-Cog

Mini-Cog Developed by Borson, 2000 “developed to help identify, in nonspecialist settings, individuals likely to have clinically important cognitive impairment” 3 -word recall task with clock drawing 3 min. administration Scored on 5 point scale

Mini-Cog Recognized, validated, well researched Often used as an initial screen Freely available Official website has information on admin and interpretation, extensive reference list, and direct links to forms https: //mini-cog. com

ACT on Alzheimers Free training resources on website: – – – Mo. CA SLUMS Mini-Cog Video of administration with client Webinars with admin and scoring instructions Direct links to forms http: //www. actonalz. org/video-tutorials