Cognitive Domain

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The Cognitive Domain involves understanding our patients' ability to understand and process their overall health. Cognitive impairment may lead to barriers in medical management, increase falls, and higher risk social living conditions.

1. Assessment tools

   The following tests may be used to evaluate a patient's cognition

   1. Mini-cog: The Mini-cog is a brief instrument to screen for cognitive impairment.
      • - Since it can be completed quite quickly, it is convenient to use on the wards or clinic
      • Test instructions
        1. 1. Ask the patient to remember 3 words
        2. 2. Ask them to draw a clock including the numbers. Place hands of clock at "10 minutes past 11"
        3. 3. Ask the patient to repeat 3 words
   2. MoCA: The Montreal Cognitive Assessment is an instrument that is now more widely used. It is more sensitive in assessing different cognitive domains, particularly visual-spatial and executive domains.
      • - The MoCA is available in different languages and versions
      • - Download MoCA Instructions handout
      • - Download MoCA Test handout
      • - More information can be found at the va.gov website
   3. MMSE: The Mini-mental status exam is a 30-point questionnaire that also measures cognitive impairment
      • - Formerly most widely used, but now trademarked
      • - Overall, it is less sensitive than the MoCA in detecting Dementia
   4. CAM: The Confusion Assessment Method is a tool used to assess for delirium
      • - Delirium: See Diagnosis section in Cognitive Domain
      • - Download CAM handout

2. Diagnosis

   Changes in cognition can be viewed on a spectrum from normal age decline to dementia:

   1. Age Related Cognitive Decline (ACRD): As we age, our cognitive function in speed and processing naturally declines. However, in normal age decline, individuals score normally on cognitive tests and are still able to perform their daily functions independently
   2. Mild Cognitive Impairment (MCI): These individuals are still able to perform their daily functions, but score lower than normal on cognitive testing
   3. Dementia: These individuals have mild to severe cognitive impairment to the point that it impairs daily functions
   4. Delirium: Primarily an acute change in attention. There are 3 types of delirium: Hyperactue, hypoacute and mixed. It is usually caused by a medical condition and can be reversed