Working with older adults as a speech-language pathologist for a rehab company, I often assess patients on their cognitive function. I will deal more in-depth on how and why determining cognitive function helps guide my treatment strategies in an upcoming post. For this first article, however, I wanted to discuss the first steps.
The first step I take in determining a person’s cognitive status involves using a standardized screening tool. I like three tests: the Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Saint Louis University Mental Status (SLUMS) exam.
Quick, easy to use, and readily available online for free, each of these screens provides different psychometric properties, organization, and administration. In other words, each one offers its own set of pros and cons.
These screening tools aren’t designed to diagnose cognitive functioning, but SLPs can use them to determine if a person’s cognitive function warrants further testing. In the next article for this two-part series, I’ll discuss why it’s important to gather information regarding possible dementia and how to use this information.
Here are the advantages and disadvantages to consider for each screening tool:
The MMSE takes about 10 minutes to administer. You can find versions translated and validated for many languages, including Persian, Greek, Italian, Chinese, Arabic, and Spanish. This screen assesses several areas—orientation, immediate memory, short-term memory, and language functioning—each of which gets scored independently for a total of 30 points. Advantages of the MMSE include brevity and ease of administration. Disadvantages include the narrow scope; inability to detect subtle memory losses; and interpretation complexity as age, education, and cultural background affect scores.
The MoCA takes about 15 minutes to administer and serves several populations and disorders, including Parkinson’s disease, vascular dementia, traumatic brain injury, Huntington’s disease, and multiple sclerosis. This screen targets several categories—visuospatial/executive functions, naming, memory, attention, language, abstraction, delayed recall, orientation—each of which is independently scored and combined for a total possible score of 30. Advantages of the MoCA include its sensitivity as a screening tool for mild cognitive impairment, Alzheimer’s disease, and dementia, as well as its ease of use. The disadvantage of the MoCA is the length of time required for administration.
The SLUMS exam takes about 7 minutes to administer. You can give the screen in multiple languages, including Polish, Spanish, French, and Chinese. This screen uses 11 questions covering several categories—orientation, short-term memory, calculations, naming of animals, clock drawing test, recognition of geometric figures—and again, each response gets scored for a total of 30. Advantages of the SLUMS include its brevity and sensitivity for mild cognitive impairment. Disadvantages of the SLUMS include the lack of research regarding psychometric properties and use with different populations.
SLPs can use any of these three screening tools to determine whether a patient requires further cognitive testing. I always determine the most appropriate screening tool to use based on the person I’m evaluating. I consider if the patient is known to have cognitive impairment as well as their stamina, cultural background, and level of education.
For example, because the MMSE doesn’t assess mild cognitive impairment, I wouldn’t use it for someone I suspect is in the earliest stages of dementia. The SLUMS does work for mild cognitive impairment, but its psychometric properties have not been as widely researched. This means we can’t be certain of its appropriateness for some populations. Like SLUMS, the MoCA demonstrates high sensitivity to mild cognitive impairment, but takes twice as long to administer.
What do you think the advantages and disadvantages of these cognitive screening tools are? Please share in the comment section below.
Bonnie Slavych, PhD, CCC-SLP, is a program manager for Select Rehabilitation in Little Rock, Arkansas, and an assistant professor at University of Central Missouri. Previously, she served as program manager for Select Rehabilitation in Central Arkansas, where she worked extensively with patients residing in skilled nursing facilities. Slavych is also an affiliate of ASHA SPecial INterest Groups 3, Voice and Upper Airway Disorders; 11, Administration and Supervision; and 13, Swallowing and Swallowing Disorders (Dysphagia). firstname.lastname@example.org