Home Academia & Research Pros and Cons of Various Screening Tools for Dementia

Pros and Cons of Various Screening Tools for Dementia

by Bonnie Slavych
An elderly man takes an assessment for dementia given by an SLP

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). slavych@ucmo.edu

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7 comments

Nidhi Mahendra June 3, 2019 - 11:58 pm

Nice insights! A few thoughts — first the MMSE does have some population norms published that allow scores to be adjusted/corrected for clients’ age and education level. Also, it is worth mentioning that the MoCA has training materials for clinicians, an eMoCA version, and is available in many more languages than with the SLUMS or MMSE.

Shelley D. Hutchins June 4, 2019 - 12:11 pm

Hi Nidhi,
Thank you for sharing your additional insights! We appreciate gaining knowledge from other’s experience!
Best,
Shelley Hutchins, content editor/producer for the ASHA Leader

Bonnie K. Slavych June 5, 2019 - 12:16 pm

Hi Nidhi! You are absolutely right about the population norms. In the SNF, we often do not know the client’s true educational level, so I typically use the abnormal cut off score of <24. But, for those where I do have this information, I definitely use this information.

Thank you for the mention of the training materials and for underscoring the language availability. It is also really important to make certain that those offered in other languages were not just translations of a version but were actually validated to ensure that we have an equivalent survey.

Bonnie K. Slavych June 5, 2019 - 12:22 pm

Also, as I think about it now, Nidhi – there is a MoCA Blind that may be used for individuals who have visual impairments. I have never used this one and have not read up on its psychometric properties. But, it is worth knowing of its availability and taking some time to determine its adequacy.

Great discussion!

Michelle Gutmann June 4, 2019 - 5:26 pm

Another option that’s not widely used but is quick to administer is the Mini-Addenbrooke’s Cognitive Evaluation (Mini-ACE, American Versions). This tool covers orientation, immediate and delayed recall, verbal fluency, and clock drawing/visuospatial abilities. It is also scored out of 30, as are the MoCA, SLUMS, and MMSE, but takes approximately 5-7 minutes to administer and approximately two minutes to score. Online booklet with detailed scoring information. Cut scores for sensitivity and specificity are provided. This test is an update of the more widely used and well validated ACE-R. The Mini-ACE was shown to be more sensitive than the MMSE and is less likely to have ceiling effects.

Shelley D. Hutchins June 5, 2019 - 11:42 am

Thank you, Michelle!
This is detailed and useful information.
Best,
Shelley

Bonnie K. Slavych June 5, 2019 - 12:24 pm

Nice one Michelle! I have not used the Mini-ACE, but I will add this to my toolbox and also tell my students of it. Thank you for the info!

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