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BMC Primary Care
Published in: BMC Primary Care 1/2017

Open Access 01-12-2017 | Research article

How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care

Authors: Jolien Janssen, Paula S. Koekkoek, Eric P. Moll van Charante, L. Jaap Kappelle, Geert Jan Biessels, Guy E. H. M. Rutten

Published in: BMC Primary Care | Issue 1/2017

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Abstract

Background

Despite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive complaints in daily practice.
In this paper we present a diagnostic algorithm for the evaluation of cognitive complaints in primary care. The rationale behind this algorithm is that the likelihood of cognitive impairment -which can be determined after history taking and an informant interview- should determine which cognitive test is most suitable.

Methods

We distinguished three likelihoods of cognitive impairment: not likely, possible or likely. We selected cognitive tests based on pre-defined required test features for each of these three situations and a review of the literature. We incorporated the cognitive tests in a practical diagnostic algorithm.

Results

Based on the available literature, in patients with complaints but where cognitive impairment is considered to be unlikely the clock-drawing test can be used to rule out cognitive impairment. When cognitive impairment is possible the Montreal cognitive assessment can be used to rule out cognitive impairment or to make cognitive impairment more likely. When cognitive impairment is likely the Mini-Mental State Examination can be used to confirm the presence of cognitive impairment.

Conclusions

We propose a diagnostic algorithm to increase the efficiency of ruling out or diagnosing cognitive impairment in primary care. Further study is needed to validate and evaluate this stepwise diagnostic algorithm.
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Metadata
Title
How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care
Authors
Jolien Janssen
Paula S. Koekkoek
Eric P. Moll van Charante
L. Jaap Kappelle
Geert Jan Biessels
Guy E. H. M. Rutten
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2017
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-017-0675-4

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