The purpose of cognitive screening tests is to aid the clinician in early detection of cognitive change as a first step toward accurate diagnosis—a process that requires further assessment. Such changes may herald the beginning of a dementia, such as Alzheimer’s disease, or may indicate an increased risk for delirium, such as in the postoperative setting,6 or functional decline with accompanying safety concerns.7 Early identification of cognitive changes provides an opportunity for case finding, crisis avoidance, and identification of patients for earlier intervention and management, including a discussion of goals with the patient, and assurance that advance directives are complete and accurate.
There is no clear consensus on who should undergo cognitive screening or how frequently it should be carried out. Screening should be targeted at individuals who are at greatest risk for either progressive dementia or delirium. Advancing age is a known risk factor for dementia, but there is no agreement on a specific age at which to initiate cognitive screening. In patients older than 80, there is a 25% to 50% prevalence of dementia,1,11,12 thus suggesting that cognitive screening should be initiated before this age. Furthermore, clinicians who provide medical care for patients of advanced age must be increasingly attentive to the possible presence of cognitive decline.