Table 2. Key Screening and Assessment Tools for Alzheimer Disease Used in Primary Care
Key Features Relevant to Clinical PracticeNumber of ItemsTime RequiredMax ScoreCutoffSensitivity/Specificity (%)
Performance testing/screening tools
  • Covers 6 areas: (1) orientation, (2) registration, (3) attention and calculation, (4) recall, (5) language, and (6) ability to copy a figure12,13

  • Quick and easy to administer

  • Can track the overall progression of cognitive decline, but not a good test for definitive/early AD diagnosis1

  • Results biased according to age, race, education, and socioeconomic status39

30 items10 minutes3023–2679/88
  • Combines an uncued 3-item recall test with a CDT that serves as a recall distractor

2 items3 minutesMaximum, 576/89
  • Easy to administer and requires no special equipment40

  • 0 = Cognitive impairment

  • Powerful predictor of impaired activities of daily living67

  • 1 to 2 + abnormal CDT = Cognitive impairment

  • Good performance in ethnolinguistically diverse populations42

  • 1 to 2 + normal CDT = No cognitive impairment

  • Easier to administer to non-English speakers39

  • 3 = Negative for dementia (no need to score CDT)

  • Less biased by low educational status and literacy level than MMSE39

  • Cognitive screening tool for detection of MCI in primary care68

  • Addresses frontal/executive functioning

  • Low susceptibility to cultural and educational biases43

  • High sensitivity and specificity for detecting MCI in those patients who perform within the normal range of the MMSE68,71

12 items10 minutes3026Sensitivity of 90% for MCI 100% for mild AD68
  • Informant-rated change

  • Screening interview: brief, sensitive measure of memory, orientation, judgment, and function

  • Can also be directly administered to the patient as a self-rating tool44

  • Use of the AD8 with a brief patient assessment, e.g. word list, could improve detection of dementia in the primary setting to 97% for dementia and 91% for MCI63

  • More sensitive to early stages of dementia: strong correlation with biological markers of AD, e.g CSF45

8 Yes/No2 to 3 minutes
  • Scores of 0 to 1 = normal cognition

  • Scores of ≥2 = probable cognitive impairment

Daily functioning assessment
  • Evaluates patient's ability to perform more complex activities that are necessary for optimal independent functioning48,49

  • Data collected from the patient or informant (e.g. family member, caregiver)

710–15 minutesThree choices of answer per question:N/A
I = Patient is completely independent
A = Assistance required
D = Dependent on help for each activity
Behavioral assessment
  • Rates frequency and severity of behavioral symptoms commonly seen in dementia, and caregiver distress57

12 symptoms/questions5 minutesEach question is scored as either present or absentN/A
  • Useful tool for family physicians; assesses both severity of symptoms in patient and distress caused to caregiver

Present behaviors are scored for severity and distress:
  • Severity: 1 = mild to 3 = severe

  • Distress: 0 = no distress; 5 = extremely distressing

  • AD, Alzheimer disease; AD8, 8-item Acertain Dementia tool; CDT, clock-drawing test; CSF, cerebrospinal fluid; IADL, instrumental (or intermediate) activities of daily living; MCI, mild cognitive impairment; Mini-Cog, Mini-Cognitive Assessment Instrument; MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment; NPI-Q, Neuropsychiatric Inventory Questionnaire; N/A, not applicable; PCP, primary care physician.