Clinical Review

Cognitive assessment of older people

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5042 (Published 07 September 2011) Cite this as: BMJ 2011;343:d5042
  1. John Young, head 1,
  2. David Meagher, professor of psychiatry2, consultant psychiatrist3,
  3. Alasdair MacLullich, professor of geriatric medicine4
  1. 1Academic Unit of Elderly Care and Rehabilitation, Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
  2. 2University of Limerick Medical School, Castletroy, Limerick, Ireland
  3. 3Midwestern Regional Hospital, Dooradoyle, Limerick, Ireland
  4. 4Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4TJ, UK
  1. Correspondence to: Professor J Young, Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ john.young{at}bradfordhospitals.nhs.uk

Summary points

  • Dementia, depression, and delirium are common and serious clinical syndromes in older people that are underdiagnosed in routine care

  • Formal detection of these syndromes may enable identification of treatable conditions, is associated with better outcomes for patients, and requires routine cognitive assessment

  • Cognitive assessment requires integration of information acquired from observing the patient and talking with carers, and from the results of an assessment instrument

  • Cognitive assessment instruments are brief, easy to use, and sensitive to cognitive impairment, but an overall clinical assessment is needed to establish the underlying cause

  • The character and time frame of cognitive problems are key considerations in establishing an accurate diagnosis and a coherent management plan

Cognitive assessment involves examination of higher cortical functions, particularly memory, attention, orientation, language, executive function (planning activities), and praxis (sequencing of activities). This article will focus on cognitive assessment of older people (those aged over about 65 years) in the context of possible dementia, delirium, and depression. These are common and serious clinical syndromes affecting older people, and accurate cognitive assessment is an essential component for diagnosis. Dementia affects 20% of people aged over 80 years,1 and delirium may affect 30-50% of older people in hospitals and an estimated 16% in long term care facilities.2 The annual incidence of major depression in the general older population is about 15% a year and doubles after age 70.3

Sources and selection criteria

We have used personal archives of references and our own experience. We also examined the guidelines on dementia, delirium, and depression published by the National Institute for Health and Clinical Excellence (NICE) and a systematic review of cognitive assessment instruments.

Case scenario: part 1

A woman aged 89 years attends your clinic accompanied by her daughter. The daughter explains that her mother has not been herself over the past few months, that she is …

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