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Dementia: assessment, management and support: summary of updated NICE guidance

BMJ 2018; 361 doi: (Published 20 June 2018) Cite this as: BMJ 2018;361:k2438
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Pharmaceutical management of dementia, including Alzheimer's disease, dementia with lewy bodies, vascular dementia, frontotemporal dementia, and cognitive impairment caused by multiple sclerosis.

Rapid Response:

Re: Dementia: assessment, management and support: summary of updated NICE guidance

The updated NICE dementia guidance on the subject of cognitive testing in primary care advocates use of brief validated tools, the specified instruments being the 10-point cognitive screener (10-CS) and the six-item cognitive impairment test (6CIT).1

As far as I can ascertain, there is only a single publication on 10-CS,2 hence no validation in independent patient cohorts. It may be a very good test, but pending further data it is difficult to understand how it can be recommended, other than on the basis of opinion of what constitutes good practice. Pragmatically, 10-CS has never been mentioned in referrals from primary care directed to this dedicated secondary care cognitive disorders clinic.3

The same cannot be said for 6CIT, which appears to be the most frequently used cognitive screening instrument in primary care in this catchment area, based on information in referrals made to this clinic. However, the negative scoring of 6CIT (higher scores worse) is associated with errors in scoring and reporting in about a quarter of referrals from primary care.3

The updated NICE dementia guidance finds no place for the General Practitioner Assessment of Cognition (GPCOG), although others have preferred it because it assesses recall and visuospatial skills, and incorporates an informant interview.4 GPCOG is frequently mentioned in referrals from primary care to our clinic, as is the MMSE.3

1. Pink J, O’Brien J, Robinson L, Longson D, on behalf of the Guideline Committee. Dementia: assessment, management, and support: summary of updated NICE guidance. BMJ 2018;361:k2438 (
2. Apolinario D, Lichtenthaler DG, Magaldi RM, et al. Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS). Int J Geriatr Psychiatry 2016;31:4-12.
3. Cannon P, Larner AJ. Errors in the scoring and reporting of cognitive screening instruments administered in primary care. Neurodegener Dis Manag 2016;6:271-6.
4. Creavin S, Wisniewski S, Noel-Storr A, et al. Cognitive tests to help diagnose dementia in symptomatic people in primary care and the community. Br J Gen Pract 2018;68:149-50.

Competing interests: No competing interests

19 July 2018
Andrew J Larner
Consultant Neurologist
Walton Centre for Neurology and Neurosurgery, Liverpool, UK