Abstract
Dementia is a global public health problem and its impact is bound to increase in the next decades, with a rapidly aging world population. Dementia is by no means an obligatory outcome of aging, although its incidence increases exponentially in old age, and its onset may be insidious. In the absence of unequivocal biomarkers, the accuracy of cognitive profiling plays a fundamental role in the diagnosis of this condition. In this Perspective article, we highlight the utility of brief global cognitive tests in the diagnostic process, from the initial detection stage for which they are designed, through the differential diagnosis of dementia. We also argue that neuropsychological training and expertise are critical in order for the information gathered from these omnibus cognitive tests to be used in an efficient and effective way, and thus, ultimately, for them to fulfill their potential.
Highlights
INTRODUCTIONA decrease in the efficiency of cognitive functioning is among the typical age-related changes (Singh-Manoux et al, 2012)
With age comes wisdom, sometimes, but psychophysical decline always does
According to recent reviews of the literature (Hwang et al, 2019; Razak et al, 2019), the most popular global cognitive function tests used to this end are: the Mini Mental State Examination (MMSE), the Mini Cog Test, the Montreal Cognitive Assessment (MoCA), the General Practitioner Assessment of Cognition (GPCOG), and the Clock Drawing Test (CDT; see Table 1)
Summary
A decrease in the efficiency of cognitive functioning is among the typical age-related changes (Singh-Manoux et al, 2012) When such decline is so significant as to markedly interfere with social, occupational or domestic functioning, it is considered pathological and is referred to as dementia. A diagnosis of Major Neurocognitive Disorder (i.e., the term that replaced the term dementia in the DSM-5) requires evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains, which may or may not include memory, as well as interference of the cognitive deficit(s) with independence in daily activities, lack of exclusive occurrence in the context of a delirium, and lack of a better explanation based on another mental disorder. The general practitioner will decide whether to proceed with further examinations and/or refer the patient for a more in-depth examination to a specialist practitioner, who will reach a definite diagnosis based on history, examination and objective assessments (Hugo and Ganguli, 2014; Falk et al, 2018)
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