Cognition - dementia, delirium and depression

Older people presenting to hospital with cognitive impairment are at greater risk of functional decline. Patients who are at risk of developing these problems during their admission are also vulnerable to functional decline. Identifying, investigating and responding to their needs is important to minimise this risk.

These topics provide information and recommend actions that we and our organisations can take to improve care for older patients.

Cognitive impairment screening

Cognitive screening, on admission to hospital and routinely throughout the stay, is important to rule out possible treatable causes. It provides a baseline to identify a decline in cognition that may be due to delirium; depression or dementia. An improvement in a person’s test scores, once treatment has been administered, can help to confirm a diagnosis of delirium.

The most commonly used cognitive assessment tools in the hospital setting are:

• the Standardised Mini Mental-State Examination (SMMSE)¹
• the Abbreviated Mental Test Score (AMTS)
• The Clock Drawing Test (CDT)

Two tools developed for use with people from culturally and linguistically diverse backgrounds are:

• Mini-Cog
• Rowland Universal Dementia Assessment Scale (RUDAS)

A tool developed specifically for indigenous Australians (remote and urban modified versions) is:

• Kimberley Indigenous Cognitive Assessment (KICA)

Informant-based questionnaires are completed by someone who knows the person being assessed well; they provide complementary information on a person’s cognitive status or can be used in situations where testing a person’s cognition is difficult due to illness, dysphasia or literacy deficit. They include:

• Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)

Complete cognitive screening using one of the tools above before administering the Confusion Assessment Method (CAM) to identify delirium.