Quick cognitive screening for clinicians : mini mental, clock drawing and other brief tests

188 Pages·1.523 MB·English

by  Kenneth I Shulman, A Feinstein

Quick Cognitive Screening for Clinicians
Mini Mental, Clock Drawing and Other Brief Tests
Quick Cognitive
Screening for Clinicians
Mini Mental, Clock Drawing
and Other Brief Tests
Kenneth I Shulman MD SM FRCPsych
FRCPC
Professor and Richard Lewar Chair
Department of Psychiatry
University of Toronto
Sunnybrook and Women’s College Health
Sciences Centre
Toronto, Ontario, Canada
Anthony Feinstein MPhil PhD FRCPC
Professor
Department of Psychiatry
University of Toronto
Sunnybrook and Women’s College Health
Sciences Centre
Toronto, Ontario, Canada
LONDON AND NEW YORK
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Cover image reproduced from Shulman (2000) Int J Ger Psychiatry 15:548–561
with permission from John Wiley & Sons Ltd.
Contents
Preface vi
Acknowledgements and Dedication vii
Chapter 1 Introduction to cognitive screening 1
Chapter 2 Premorbid intellectual functioning 11
Chapter 3 Mini Mental State Examination 26
Chapter 4 The Clock Drawing Test 40
Chapter 5 Tests of frontal lobe function 76
Chapter 6 Short cognitive screening tests and batteries 98
Chapter 7 Informant questionnaires 121
Chapter 8 Neuroimaging correlates of cognitive 136
dysfunction
Chapter 9 Clinical vignettes 157
Index 171
Preface
This collaboration on cognitive screening brings together two
rapidly growing and overlapping fields, namely geriatric psychiatry
and neuro-psychiatry. As colleagues in the same department, we
came to realize the importance of sharing our expertise and
experience of assessing and treating a wide range of central
nervous system (CNS) disorders. The fields of psychiatry,
geriatrics, neurology, neuropsychology and primary care all share
a role and vested interest in the early identification of brain
disorders as well as having the capacity to monitor cognitive
changes over time.
The book focuses on the brief or ‘quick’ cognitive screening
instruments. Inevitably, there is a selection bias on the part of the
authors in terms of which instruments we chose to review and their
relative emphasis. However, we did strive for objectivity in
reviewing those instruments most widely used and studied. We
also felt that a chapter devoted to frontal lobe tests was necessary,
given the importance of this brain region in modulating behavior
and cognition. In this book, we summarize the current state of
knowledge related to the development of cognitive screening
instruments. Hopefully, readers will find the book of academic
interest and practical value in their daily clinical work.
Kenneth I Shulman
Anthony Feinstein
Acknowledgements
We gratefully acknowledge the help of Dilshad Ratansi in the
preparation of the manuscript and Abigail Griffin for her careful
editing of the text.
Dedication
We dedicate this book to our families:
Karen, Pippa, Saul and Clara
Rhona, Rayzie and Tamara
Chapter 1
Introduction to cognitive screening
Why cognitive screening?
With a rapidly growing elderly population comes the ‘demographic
imperative’ that neuropsychiatric disorders will become one of the
major clinical and public health challenges of the next generation.
The dementias and neuropsychiatric disorders in this population,
as well as in younger patients, represents a challenge for which we
are still largely unprepared. While many of these conditions are
not reversible, secondary and tertiary prevention are realistic and
important goals for health-care systems around the world.
Prevention involves early diagnosis and treatment, but also
disability limitation and the prevention of complications resulting
from those disorders (Ganguli, 1997). Ganguli rightly makes the
point that ‘No cognitive screening measure is an Alzheimer’s test;.
While non-professionals can generally perform screening, those
who test positive need to be targeted for more skilled and detailed
assessments. Although screening represents only the first step in
a process of assessment and ‘work-up’, it still offers the best
opportunity for secondary prevention (Ganguli, 1997).
Early detection carries with it a number of important potential
benefits from a clinical as well as a societal perspective:
1.The early diagnosis of a neuropsychiatric or dementing
disorder offers the opportunity to provide an explanation to
patients and families regarding changes in cognition,
functioning, behavior or mood.
2.The establishment of a firm diagnosis allows for planning of
important issues for the patient and family. This includes the
preparation of Powers of Attorney for property and personal