Clinical Question

In the primary care setting, what is the best approach for the initial evaluation of patients with suspected dementia?

Evidence Summary

When there is concern for cognitive impairment, based on history or expressed by family members, quick and effective tools for the initial evaluation of dementia are essential for diagnosis. Many tools are available, including the General Practitioner assessment of Cognition (GPCOG) and the Mini-Cog instrument. If the initial evaluation is positive, an in-depth cognitive evaluation should be performed.

The GPCOG, available at https://gpcog.com.au, takes less than four minutes to complete. It is a six-item verbal evaluation that incorporates tests of memory, orientation, and clock drawing followed by a brief questionnaire for a family member or close friend to answer. It has been evaluated in a single large, well-designed primary care study in Australia and had similar accuracy to the Mini-Mental State Examination (MMSE).1 Compared with the reference standard of a comprehensive interview, it was 79% sensitive and 92% specific (positive likelihood ratio [LR+] = 9.9; negative likelihood ratio [LR–] = 0.23).