Just screening for memory or cognitive functions may not result in an accurate diagnosis of dementia. The author suggests going deeper because of the possibility of comorbid situations and discusses a variety of screening tests.

Providing timely assessment of cognition, mood, and behaviour in order to facilitate effective treatment for older adults is encouraged(2). This is important for older adults with cognitive difficulties that may indicate dementia(3), particularly in primary care settings(6,11). However, older adults in general remain under-assessed for psychiatric and neurological conditions(5, 7), including dementia.

Changes in cognition in later life may arise from several causes, including medical illnesses and medication side effects, and comorbid psychiatric presentations such as depression or anxiety. Screening of cognitive functioning is often useful for clinicians working with older clients, but is particularly important if dementia is suspected or diagnosed, and recent cognitive data (e.g., neuropsychological testing within 3 months) is not available(9). However, just completing a brief cognitive screen might in fact miss critical affective information from the patient which could assist the clinician obtain a more accurate picture of the breadth of presenting problems, and point our areas requiring more in-depth assessment.

Older adults may experience declines in cognition for many reasons, including stress, medical illnesses and medication side effects, and comorbid psychiatric conditions such as depression or anxiety, and this is important to be aware of if a question of dementia arises(17). Screening of cognitive functioning is often useful for clinicians working with older clients, and is particularly important if dementia is suspected or diagnosed, as such screening may pick up previously undocumented cognitive declines or changes, and may serve as a useful basis for a referral for neuropsychological testing(9).

Brief cognitive screens, such as the Montreal Cognitive Assessment (MoCA)(14), Modified Mini-Mental State Exam (3MS)(19), and the Rowland Universal Dementia Assessment Scale (RUDAS)(18), are all in relatively wide use for persons suspected of dementia or mild cognitive impairment. These instruments have good psychometric properties, and have some advantages over the MMSE with respect to overcoming educational and cultural biases(9).

However, brief assessments should go beyond assessing memory and cognition. Depressed and anxious older adults often cite memory problems as a significant symptom, more so than younger populations(4, 8). Brief screening tests such as the Geriatric Depression Scale (GDS)(20) and the Geriatric Anxiety Inventory (GAI)(15) are appropriate for older persons with suspected cognitive decline who can still manage self-report inventories. The Cornell Scale for Depression in Dementia (1) and the Rating Anxiety in Dementia scale(16) are appropriate if self-report is no longer an option for the patient with dementia, and informant reports on mood and anxiety are required.

While screens for cognitive and affective functioning serve a useful purpose when used as intended, these measures are counter-productive when used as diagnostic tools or as a substitute for a complete clinical interview, especially when used as the sole basis for diagnosis(10, 13). For example, symptoms of agitation which are commonly seen in dementia may be difficult to differentiate from anxiety in later life, and therefore warrant careful attention(12).

Thus, use of cognitive screening instruments is an efficient, evidence-based method of identifying older adults who may require more extensive assessment, but these instruments should supplement, rather than supplant, broader clinical interview and assessment approaches.