Analysis of Cognitive Testing in
Rubislaw Medical Practice
Dr Jonathon Taylor, Rubislaw Place Medical Group, Aberdeen
2013
Introduction
Over the years a variety of different tools have been developed
to test cognition and screen for cognitive impairment.
The NICE guideline 42 revised in 2011 recommends the
assessment of cognitive decline using one of four
standardised instruments:
1.
2.
3.
4.
Mini Mental State Examination (MMSE)
6-Item Cognitive Impairment Test (6-CIT)
General Practitioner Assessment of Cognition (GPCOG)
7-Minute Screen
Aim
The aim of this project was therefore to assess the practice
attitudes towards cognitive assessment and answer the
following:
1.Which tools are employed by the Doctors of Rubislaw Place
Medical group in the assessment of cognitive decline.
2.The awareness of the variety of tools available and the
attitudes to using these in the primary care setting.
Methods
30 medical records were randomly selected from patients
currently contained within the QOF dementia register.
The case notes were examined and the tool used prior to
referral for secondary care assessment was recorded.
The Doctors within the practice were posed questions about
their attitudes and awareness of available tools.
Results
Of the 30 records examined 6 of the patient’s were diagnosed
with dementia following hospital admission – there had been
no previous cognitive testing performed in primary care and
therefore they were excluded.
Of the remaining 22 records the method of cognitive testing
performed in primary care is illustrated below.
8 patients were not cognitively assessed prior to referral. In
these patients the documented history was very suggestive of
cognitive decline and no formalised cognitive testing was
performed prior to referral.
None of the doctors within the practice were had used any of
the tools mentioned in the NICE guideline other than those
recorded above.
The most important factor in determining which tool used was
the time taken to perform with 100% of doctors stated this as
the determining factor.
50% of the doctors performed the cognitive test themselves
during consultation with 50% requesting the patient to return
to see the practice nurse or arranging District nurse home visit
for this purpose.
Conclusions
Overall the most commonly used cognitive assessment tool
was the MMSE. Less commonly used was the older tool of
AMT and the more recently developed Montreal Cognitive
Assessment (MOCA). This likely reflects the local practice
instilled by the Secondary Care Old Age Psychiatry
department.
The reasons for not performing cognitive testing within the
primary care setting is likely influenced by a number of factors
but by far the most influential was time taken to perform given
the constraints of the primary care consultation.
Given that many of the tools share elements and the aim of the
assessment is for the most part case finding of patients whom
would benefit from secondary care assessment it is concluded
that the actual tool employed is less important that being able
to correctly use and interpret the results. For the purposes of
continuity of care, patient monitoring and correct diagnosis it
seems important that local practice is standardised so that the
tools adopted in secondary care are used where possible in
the primary care setting .
Learning Points
Personally I feel the Dementia Scholarship has greatly
improved my understanding of both the correct diagnosis of
Dementia and the post diagnosis care and support of patient,
families and carers.
Number of Patients
8
7
6
5
Number of
Patients
4
3
2
1
0
None
AMT
MMSE
MOCA
I feel better placed and suitably informed to cascade this
knowledge to the doctors and nurses within my practice.