Table 2. Key Screening and Assessment Tools for Alzheimer Disease Used in Primary Care

	Key Features Relevant to Clinical Practice	Number of Items	Time Required	Max Score	Cutoff	Sensitivity/Specificity (%)
Performance testing/screening tools
MMSE	Covers 6 areas: (1) orientation, (2) registration, (3) attention and calculation, (4) recall, (5) language, and (6) ability to copy a figure^12,13 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 items	10 minutes	30	23–26	79/88
Mini-Cog	Combines an uncued 3-item recall test with a CDT that serves as a recall distractor	2 items	3 minutes	Maximum, 5		76/89
	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
MoCA	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 MMSE^68,71	12 items	10 minutes	30	26	Sensitivity of 90% for MCI 100% for mild AD⁶⁸
AD8	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/No	2 to 3 minutes	Scores of 0 to 1 = normal cognition Scores of ≥2 = probable cognitive impairment		74–80/80–86
Daily functioning assessment
IADL	Evaluates patient's ability to perform more complex activities that are necessary for optimal independent functioning^48,49 Data collected from the patient or informant (e.g. family member, caregiver)	7	10–15 minutes	Three choices of answer per question:		N/A
				I = Patient is completely independent
				A = Assistance required
				D = Dependent on help for each activity
Behavioral assessment
NPI-Q	Rates frequency and severity of behavioral symptoms commonly seen in dementia, and caregiver distress⁵⁷	12 symptoms/questions	5 minutes	Each question is scored as either present or absent		N/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.