Cognitive tests to help diagnose dementia in symptomatic people in primary care and the community

What brief cognitive test should a busy GP use when trying to assess someone who might have dementia? The menu of choices is long; one review found 11 options.1 The Cochrane Dementia and Cognitive Improvement Group (CDCIG) is conducting a series of reviews to evaluate the evidence of a range of tests for diagnosing dementia. To date, reviews have been published addressing the accuracy of two tests in primary care: the Informant Questionnaire for Cognitive Disorders in the Elderly (IQCODE) and the Mini Mental State Examination [MMSE]. Reviewers found only one study that investigated the use of the IQCODE in primary care,2 and six that investigated the use of the MMSE.3 A review of the Montreal Cognitive Assessment [MoCA] found no studies that evaluated the accuracy of the test in primary care.4 Reviews are underway for the Mini-Cog and AD-8 tests (see http://dta.cochrane.org/reviews-and-protocols-crg). The IQCODE is a structured informant questionnaire; 26-item and 16-item versions exist and scores range from 1 (no impairment) to 5 (more impairment).4 In the one study that investigated the use of the IQCODE at a threshold of 3.2 in primary care the sensitivity was 100% and specificity 76%, whereas at a threshold of 3.7 the sensitivity was 75% and specificity 98%.2 The MMSE is one of the oldest and therefore …