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Exploring What Assessment Tools Are Used for Dementia Monitoring Following Diagnosis

August 3, 2021Neelem Sheikh

Patients and their families or caregivers need to understand what assessment tools are used for dementia after receiving a diagnosis. To understand how an individual’s dementia is progressing over time, measurement tools can be applied. This is also critical for individuals who are implementing lifestyle changes or are undergoing treatment for dementia to understand how their treatments are affecting or improving brain function.

Let’s examine what to look for in an assessment tool as well as what assessment tools are used for dementia, including traditional pencil and paper cognitive tests, functional performance tests, and integrated cognitive and functional assessment tools.

What to Look for in an Assessment Tool

When choosing among dementia monitoring tools, there are a few characteristics to look for to ensure the acquired data is meaningful and reliable. The following are important attributes to consider when deciding which monitoring tool is the best choice:

  • Measurement tools that assess both cognitive and functional aspects of brain function can provide greater insight.
  • Tools that provide a higher granularity of data result in a more comprehensive understanding of dementia progression.
  • Assessments that do not require a human to administer or coach an individual through the test reduce the risk of bias and human-to-human variability.
  • A detailed scoring system and measurement scale can provide a greater degree of insight into brain function. 

What Assessment Tools Are Used for Dementia Monitoring?

Traditional pencil and paper methods assess brain function as it relates to memory, whereas functional performance methods analyze physical performance. Below, we detail examples of traditional pencil and paper tests, functional performance tests, and newer technologies that combine both cognitive and functional aspects.

Traditional Pencil and Paper Cognitive Tests

The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Mini-Cog are the most commonly used cognitive tests and require a healthcare professional to administer.

The MMSE is a routine cognitive screening test that examines orientation, attention, calculation, language, and visuospatial abilities. Both the MMSE and MoCA are rated on a 30-point scale. The MMSE takes between five to 10 minutes to administer, while the MoCA takes between 10 to 15 minutes. The MoCA incorporates the same aspects of the MMSE while adding a Clock Drawing Test (CDT) and Trail Making Test. 

During a CDT, the patient is tasked with drawing a clock, placing the numbers in their proper locations, then “setting” the clock to a specific time. The Trail Making Test is a two-part assessment where the patient first connects 25 numbered circles, starting with one and ending at 25, as quickly and accurately as possible. During the second part of the test, the patient must connect 25 numbered and lettered circles, alternating between numbers and letters. In other words, the path is to be traced following the pattern “1-A-2-B-3-C-4-D” and so on.

The Mini-Cog is designed to be a three-minute screening tool scored on a five-point scale and consists of two aspects—a three-item recall test and the CDT. 

Functional Performance Tests   

While the MMSE, MoCA, and Mini-Cog aim to analyze cognitive aspects of dementia, functional performance tests aim to analyze physical performance aspects of dementia. Dementia not only results in cognitive deficits but also a decline in physical performance, which may hinder an individual’s ability to perform daily tasks. Thus, understanding how an individual’s functional performance changes over time can help direct their care and treatment. 

The below tests analyze aspects of physical performance that correlate with an individual’s ability to perform day-to-day activities.

  1. Gait speed: Patients must walk in a straight line at their normal pace for six meters. Walking speed is measured and averaged over two attempts, with higher scores reflecting higher performance.
  2. Dynamic balance: Patients walk two laps of a standard 10-meter, figure eight-shaped course (Figure-of-Eight Walk Test). They must follow the contours of the course as quickly and accurately as possible. The quickest time of two attempts is recorded, with shorter durations indicating higher performance.
  3. Functional mobility: Patients are tasked with standing up from a chair, walking three meters, turning around, walking three meters back, and sitting down in the same chair at their typical pace (Timed “Up & Go” Test). The time taken to complete the activity is averaged, with shorter durations suggesting higher performance.
  4. Static balance: Patients must stand in four different stances with their eyes open (and without assistance devices) with the goal of holding each pose for 10 seconds (Frailty and Injuries: Cooperative Studies of Intervention Techniques). Based on the success or failure of maintaining each stance for 10 seconds, a score is assigned and totaled for all stances, with higher scores reflecting higher performance.
  5. Lower-limb strength: Patients must get up from a chair, stand up straight, and sit down again as many times as they can within a 30-second interval (“Chair Rise” Test). The total number of sit-to-stands is measured, with a higher score indicating higher performance.
  6. Grip strength: Patients are tasked with standing and holding a dynamometer in their dominant hand with their arm extended and palm facing their leg, then squeezing the grip as hard as they can. The strongest of three attempts is recorded, with a higher score reflecting higher performance.

While the physical performance tests detailed above are suitable for detecting differences in functional performance between older individuals with mild to moderate dementia, studies indicate that they may be less suitable for monitoring performance changes within a particular individual.

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