Diagnosis and screening
Tools for healthcare professionals to support dementia screening, assessment, and early diagnosis.

Overview
Alzheimer's disease and other dementia are progressive, degenerative diseases. Individuals or their family members may consult a family physician when they begin to notice symptoms such as loss of memory, judgment and reasoning, difficulty with day-to-day tasks and changes in communication abilities, mood and behaviour.
Cognitive impairment and dementia are present in about 20 per cent of the elderly population and are consistently rated among the top three concerns of older adults.1 Early detection of dementia provides an opportunity for the individual to adjust to the diagnosis and to participate actively in planning for the future.
Screening
- Instruments to detect cognitive impairment in older adults
- Canadian Medical Association article on Diagnosis and treatment of dementia
- Vascular dementia - Targeted Screening for Dementia (PDF) by William B. Dalziel, MD, FRCPC
Source: The Canadian Review of Alzheimer's Disease and Other Dementias - Diagnosing Alzheimer's disease and related disorders from the I Can! I Will! Idea Library of Alzheimer's Disease International
- Depression vs. Dementia: How Do We Assess? (PDF) by Lilian Thorpe MD, PhD, FRCP
Source: The Canadian Review of Alzheimer's Disease and Other Dementias - The Assessment and Treatment of Delirium 2014 guideline update from the Canadian Coalition for Seniors' Mental Health
- Burns A, Bagshaw P, A new dementia currency in primary care. NHS England, March 2016.
Watch the video I’m a doctor - is there a good way to check out a memory complaint? A five-step brain health check for doctors.
The material was created by TCD, through the NEIL Programme at the Institute of Neuroscience with support from GENIO.
© 2014 The Provost, Fellows, Foundations Scholars, and the Other Members of Board, of the College of the Holy and Undivided Trinity Of Queen Elizabeth, near Dublin. Permission to use this material was granted by TCD which reserves all rights in the material.
Early diagnosis
Early diagnosis is important. Symptoms of irreversible dementia can be similar to those of other conditions such as depression, thyroid or heart disease, infections, drug interactions or alcohol abuse.
Finding out the cause of the symptoms can help people understand the source of the symptoms, get the proper care, treatment and support and plan for the future.
Cognitive screening tests
Instrument | Reference | Time (min) |
Cut-off score/Total score |
Mini-mental state examination | Folstein et al., 1975 |
7-10 | ≤23-26/30 |
Hopkins verbal learning test – total recall | Frank and Byrne, 2000 |
5 | ≤14-18/36 |
Memory impairment screen | Buschke et al., 1999 |
4 | ≤4/8 |
Clock drawing test | Royall et al., 1992 |
1-3 | Scoring methods varied |
Cambridge cognitive examination | Lolk et al., 2000 |
20 | ≤80/107 |
Modified mini-mental state examination | McDowell et al., 1997 |
10-15 | ≤77-86/100 |
Community screening interview for dementia | Hall et al., 1993 |
30 | Formula used |
Montreal cognitive assessment | Nasreddine et al., 2005 |
10 | ≤25/30 |
Behavioural neurology assessment Long form |
Darvesh et al., 2005 |
40-50 | ≤182/250 |
Behavioural neurology assessment Short form |
Darvesh et al., 2005 |
20-30 | ≤82/114 |
Cognitive loss and hearing loss
Did you know…
- There is a clinically significant association between hearing loss and cognitive decline. Individuals with hearing loss demonstrate an accelerated rate of cognitive decline and an increased risk for cognitive impairment3.
- The potential mechanisms behind this relationship between hearing loss and cognitive loss, in particular the increased risk for incident dementia4, remain to be determined. Possible rationales for this association may include increased social isolation, changes to the brain, and/or a common process that is influencing both hearing and cognitive functioning in older individuals.
Below you will find some issues that may be common in your practice, some implications for assessment, and some suggestions for solutions you can implement to ensure that you are providing your patients with the best care possible.
Issue |
Implications for Cognitive |
As individuals age, they may experience changes in their auditory processing and/or cognitive abilities. |
|
People with hearing loss may be hesitant to seek help. |
|
Cognitive testing (e.g. the MMSE, the MoCA) often relies heavily on an individual’s ability to hear and respond to questions and instructions given5. |
|
Behavioural symptoms (e.g. repetition, agitation) that are commonly attributed to the individual’s cognitive loss, may be related to and/or exacerbated by hearing loss. |
|
4th Canadian Consensus Conference on Diagnosis and Treatment of Dementia
The 4th CCCDTD convened in May 2012 in Montreal with the primary aim of updating the previous diagnostic approach to Alzheimer’s disease, taking into account the revised diagnostic criteria proposed by the International Working Group (IWG) and the recommendations made by the National Institute on Aging—Alzheimer Association workgroups.
Alzheimer Society brochures for further reading
Some of the following brochures are written for clinicians and others are intended for individuals and their families, or both.
Clinicians:
- The importance of early diagnosis | Print-friendly version
- Principles for a dignified diagnosis
- Questions for family physicians and health professionals to ask when cognitive impairment is suspected
- Global deterioration scale
Individuals and family members:
References
- Feldman H, et al., Diagnosis and treatment of dementia. Canadian Medical Association Journal, 178 (March 2008), 825- 36.
- "Assessing patients complaining of memory impairment",Geriatrics & Aging (April 08, volume 11, number 3), Dr. M. Masellis and Dr. S. E. Black.
- Gurgel RK et al. “Relationship of hearing loss and dementia: A prospective, population-based study”, Otology & Neurotology, 2014.
- Lin FR et al. “Hearing loss and incident dementia”, Archives of Neurology, 2011, 68(2), 214-220.
- Schneider BA et al. “Effects of senescent changes in audition and cognition on spoken language comprehension”, The Aging Auditory System, Springer Handbook of Auditory Research, 2010, Vol. 34, 167-210. Schneider BA et al. “Effects of senescent changes in audition and cognition on spoken language comprehension”, 2010, Vol. 34, 167-210.
- Davis A et al. “Acceptability, benefit and costs of early screening for hearing disability: A study of potential screening tests and models”, Health Technology Assessment Journal, 2007, 11(42):1-294.
- Pichora-Fuller MK et al. “Helping older people with cognitive decline communicate: Hearing aids as part of a broader rehabilitation approach”, Seminars in Hearing, 2013, 34(04): 308-330.
- Lewis‐Cullinan C, Janken JK, “Effect of cerumen removal on the hearing ability of geriatric patients”, Journal of advanced nursing, 1990, 15 (5), 594-600.
- Moore A et al. “Cerumen, hearing, and cognition in the elderly”, Journal of the American Medical Directors Association, 2002, 3 (3), 136-139.
More useful links and resources
Joining up: Why people with hearing loss or deafness would benefit from an integrated response to long-term conditions, a report from Action on Hearing Loss and the Deafness Cognition and Language (DCAL) Research Centre, 2013.
The importance of considering hearing needs in individuals with cognitive impairment, ASC CDRAKE webinar, presented by Kate Dupuis, Clinical Neuropsychologist, and Debbie Ostroff, Registered Audiologist (May 14, 2014). Read the transcript.
Exploring the connections between hearing loss and cognitive health, a brainXchange webinar presented by Dr. Kate Dupuis, hosted by brainXchange in partnership with the Alzheimer Society of Canada and the Canadian Consortium on Neurodegeneration in Aging (CCNA).