Impaired Cognition

  • Perform a patient-centred interview that will help to identify a patient that may be at risk of cognitive impairment, including an interview with a relative or friend if necessary. The information gathered should include current functional status, current living environment, current supports available and potential safety concerns.
  • Perform a formal clinical assessment of dementia using a evidence based tool e.g. MOCA
  • Propose an initial investigation for secondary causes of dementia
  • Propose an initial management plan of dementia, including non-pharmacologic and pharmacologic options

Articles

Dementia

Freedman A, Vasa P Dementia One-Page Primer. DFCM Open. 2011. Available at: http://dfcmopen.com. Attribution CC BY-NC-ND

Recommendations on Screening

Canadian Task Force on Preventive Health Care, Pottie K, Rahal R, et al. Recommendations on screening for cognitive impairment in older adults. CMAJ. 2016;188(1):37-46. doi: 10.1503/cmaj.141165 [doi].

MMSE

Pfizer Canada Inc. Instructions for administering the Mini-Mental State Examination (MMSE). 2007. Available from http://gem.rgp.toronto.on.ca/

MoCA Test English

Nasreddine Z. Montreal Cognitive Assessment. Version 7.1. Available at: http://www.mocatest.org/

MoCA Instructions English

Nasreddine Z. Montreal Cognitive Assessment (MoCA) Version 3: Administration and Scoring Instructions. May 2011. Adapted by Nasreddine Z, Phillips, Chertkow NH. Available at: http://www.mocatest.org/

Behavioural Treatment Options for Dementia

Alzheimer’s Association. Challenging Behaviors. 2011. Available at: https://www.alz.org/

CEP_Guide for Primary Care Management of Mental Health and Addictions

Centre for Effective Practice in collaboration with Ontario College of Family Physicians and Nurse Practitioners’ Association of Ontario.  Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and
Addictions-related Risks and Functional Impairments.  February 2017.