MOCA. It is sensitive to mild cognitive impairment.

I would also recommend MoCA.

Let me recommend to you a manuscript of Livingston G et al.

I guess it depends the type of test you are after and the type of dementia you want to detect:

1) If you want a biomarker, a PiB scan will tell you whether there is Abeta protein deposition in the brain. Another useful scan is FDG-PET which will provide you a map of brain regions that are metabolically hypoactive. Another biomarker (but not as reliable) is CSF and looking at ratios of different proteins (e.g. tau/phospho tau; Abeta42/Abeta40).

2) If you are after a clinical/bedsite test, MoCA is good. An alternative is the ACE (Addenbrooke's Cognitive Examination). It is a broad screening instrument that can be administered in ~15 min and cover the main cognitive domains (attention, memory, language, visuoperceptual, executive). It is scored out of 100, with normal scores being 88 and above. It is sensitive to presence of cognitive deficits and has also good specificity in differentiating Alzheimer's disease from frontotemporal dementia.  

Details on the ACE, which is in its third iteration, can be found at http://www.neura.edu.au/frontier/research/test-downloads/. There is also now an app available for the ACE, which is freely available (http://www.acemobile.org)

If you are testing a healthy older adult sample I recommend the Mini Mental State Exam. I generally use a cut off score 27 with a score below 27 indicating MCI or onset of dementia. 

The Self-Administered Gerocognitive Exam (SAGE) is new MoCa and MMSE are also okay . Sage in my opinion is the best of the 3 .

The reaction to sarcastic comments could give rise to a suspicion.

http://www.ucsf.edu/news/2011/04/9719/inability-detect-sarcasm-lies-may-be-early-sign-dementia-ucsf-study-shows

http://www.eurekalert.org/pub_releases/2014-07/aeco-sws072514.php

http://www.sciencedaily.com/releases/2009/06/090609220603.htm

http://medicalxpress.com/news/2012-01-decade-pet-effectively-dementia.html

http://phys.org/news/2012-10-home-based-tool-dementia-screening.html

http://medicalxpress.com/news/2011-10-biological-fingerprints-diagnosis-dementia.html

http://www.eurekalert.org/pub_releases/2013-02/mc-npm021113.php

Regards,

Joachim

I agree that the problem of dementia is important at different ages and different layers of the population. Suffering is absolutely necessary sympathy. Bad when dementia masked elegant clothes, verbosity and position.

I'm not particularly keen on the MOCA myself.  If you've got 15 minutes to spend. the ACE or the RBANS would be my assessments of choice.  The local primary care folk (who only have a few minutes) use the 6-CIT.  MMSE now copyright and also notoriously insensitive.  If you're out and about with nothing with you then clock drawing, asking people to recite the months backwards, and asking people what they'd need to pack to go on holiday covers a lot of the executive and planning basics but obivously not standardised - if you suspected anything you'd still need to get them into a clinic to use a proper measure.

MMSE and the drawings of a house and a clock

I also recommend MoCA, www.mocatest.org

It depends most by the setting where you are with the patient. Try these:

SPMSQ di Pfeiffer, MMSE, MoCA, 4AMT, ACE, Clock test, FAB.

Remember that the scoring systems are useful but it is more correct if you explain the results with scores AND a description of the domains involved in impairment.

Good luck!

Dear All,

There is many options available to detect dementia from a clinical point of view, many of them have been previously cited in the former answers. So, I'm only going to add two papers :

The first ones are two interesting sistematic reviews by Mitchell et al (2008):

http://www.ncbi.nlm.nih.gov/pubmed/20808118

http://www.ncbi.nlm.nih.gov/pubmed/20808094

And secondly, one of my own papers, in which we present the most effective test to date to rule out dementia cases, as a first step in a hierarchical diagnostic process:

http://www.ncbi.nlm.nih.gov/pubmed/23773305

Usefulness of 2 questions about age and year of birth in the case-finding of dementia.

OBJECTIVE:

To test the hypothesis that the efficacy of 2 simple questions commonly used in clinical practice, asking the age and year of birth of individuals, will be satisfactory to rule out cases of dementia.

DESIGN:

Population-based, longitudinal, prospective study focused on the incidence of dementia. In the baseline, a 2-phase procedure for identifying cases and noncases of dementia was implemented.

SETTING:

Zaragoza, Spain.

PARTICIPANTS:

Individuals 65 years or older without previous diagnoses of dementia (n = 3613) drawn from the population-based random sample of the ZARADEMP project.

MEASUREMENTS:

Standardized instruments were used, including the Geriatric Mental State (GMS) and the History and Aetiological Schedule (HAS); cases were diagnosed according to DSM-IV criteria ("reference standard"). The simple cognitive test used in this study consists of the following 2 compulsory questions: "How old are you?" and "What year were you born?"

RESULTS:

The test was well accepted by the participants and took less than 30 seconds to complete. Compared with the "reference standard," validity coefficients for incorrect answers in both questions were as follows: sensitivity 61.2%, specificity 97.8%, positive predictive value 44.4%, negative predictive value 98.9%.

CONCLUSIONS:

This ultra-short test has very good specificity and negative predictive power. Its use to rule out cases of dementia might be generalized, as it has the best efficiency reported to date.

I hope you find it usefull,

I would recommend the use of RBANS or NAB (Screening Module), both of which should take about 30 -45 minutes to administer. These tools are reliable, sensitive and its specificity to neurocognitve disorders are being well documented in major literatures (especially the RBANS).

just downloaded: hoping it may be useful, Mauro Colombo

Actually we are assessing a questionnaire on self-perceived cognitive blackouts, which may be a useful screening tool for incipient dementia.

Conference Paper Checklist for Cognitive Blackouts (CCB): evaluation of a scr...

Hi. Many of the researchers have proposed brief neuropsychological batteries that may be appropriate such as Moca and ACE. However, the most important thing is identity in impact of cognitive impairment in the activities of the patient's daily life. Regards

There is no brief cognitive sreening test that allows a definitive diagnosis of dementia. However, the diagnosis of MCI in its amnesic form can be diagnosed with instruments such as MoCA and ACE-III. The exploration can be complemented with the use of the FAB and the INECO Frontal Screening. The exploration of the patient must also consider the study of personality, activities of daily living, among other factors. Good luck!!

Yunier Broche-Pérez: I do agree: further, some behavioural and psychic disorders may bother early in MCI. before heavy decline in daily life Regards, Mauro,