Cognitive assessments most commonly used by clinicians are the MMSE and the MoCA.1 The MMSE assesses global cognitive efficiency and is usually used to evaluate the dementia stage and overall progression of cognitive decline.2 However, the ability of the MMSE to detect cognitive decline is less sensitive in mild than moderate stages of AD.3
Sometimes, the MMSE is misunderstood as a diagnostic test rather than what it actually is – a screening test with relatively modest sensitivity.4 Particularly for low-educated individuals, the MMSE contains hindrances such as counting or spelling backwards, as well as writing and reading.1 The MoCA was originally developed to screen for MCI.4 It takes some structured training and can be administered by any clinician in approximately 10 minutes.4 The performance of the MoCA is similar to the MMSE, including for screening for dementia.4 Additionally, as it assesses executive function, it can be useful for patients with vascular impairment, including those with vascular dementia.4
The NPI assesses the frequency and severity of a range of behaviours commonly observed in dementia.4 Similar to the MoCA, the NPI takes approximately 10 minutes for a clinician to administer to a carer.4 Overall, the NPI has good psychometric properties and is widely used in drug trials, and is short enough for use in clinical practice.4
There are several ways of carrying out activities of daily living, making it difficult to obtain ADL ratings from an informant in a standardized way for a clinical trial.5 The ADCS-ADL Inventory provides a solution by offering detailed descriptions of each activity, and by asking the informant to describe observed actions or behaviours.5,6 When administering the ADCS-ADL, the informant is asked to focus on the past 4 weeks, and explain what the patient did, rather than focus on what they may have done if the scenario would have occurred.6 In summary, the ADCS-ADL Inventory was developed and tested as an interview administered by a rater in person or by telephone, and should not be filled out by the informant.5
References:
1.Gauthier S. Cognitive assessments. Key points. In: Gauthier S, Rosa-Neto P, Morais JA, Webster C. World Alzheimer Report 2021: Journey through the diagnosis of dementia. Available at: https://www.alzint.org/u/World-Alzheimer-Report-2021.pdf. Accessed 15 November 2023.
2.Sarazin M, Olivieri P, Lagarde J. How do cognitive symptoms progress over time? In: Gauthier S, Webster C, Servaes S, et al. World Alzheimer Report 2022: Life after diagnosis: navigating treatment, care and support. Available at: https://www.alzint.org/u/World-Alzheimer-Report-2022.pdf. Accessed 15 November 2023.
4.Sheehan B. Assessment scales in dementia. Ther Adv Neurol Disord 2012; 5 (6): 349–358.
5.ADCS-ADL Inventory. Available at: https://www.dementiaresearch.org.au/wp-content/uploads/2016/01/ADCS-ADL_Manual.pdf. Accessed 8 November 2023.
6.Fish J. Alzheimer’s Disease Cooperative Study ADL scale. In: Kreutzer JS, DeLuca J, Caplan B (eds). Encyclopedia of Clinical Neuropsychology 2011. Springer, New York, NY. https://doi.org/10.1007/978-0-387-79948-3_1791