One of the reasons to assess the relative merits of the MMSE is that it is a proprietary instrument, owned by ‘Psychological Assessment Resources’ meaning that it is not actually free for organisations to use. As the authors of this paper state, the performance of the MMSE in detecting dementia as compared to other tests has not been systematically assessed and so, that is what they set out to do. The test itself takes about 10 minutes to complete. In this test you can score up to 30 points by answering a range of questions that test your orientation to time and place, your memory, attention and so on. The commonest cognitive test used is called the Mini-Mental State Examination (MMSE). Obviously, an exhaustive assessment of a person’s cognitive function would take a very long time – hours, if not longer! While researchers may have hours to spend with patients, most busy clinicians do not and so the Holy Grail is finding a good, brief screening test of cognitive function that allows us to diagnose dementia. ‘Cognitive’ here means the ‘higher brain functions’ I alluded to earlier things like memory, numeracy, visual perception, personality change and planning, to name a few. The way we diagnose and detect dementia, therefore, is by systematically assessing the function of various brain regions by using cognitive tests. By comparison, frontotemporal dementia affects the frontal area of the brain first and, as a result, these patients often have changes in personality and difficulties in planning long before they have difficulties with memory. For this reason patients with Alzheimer’s disease get memory problems early on. For example, early on in the disease course Alzheimer’s affects an area of the brain called the hippocampus, which is involved in storing memories about our lives. The symptoms a particular person with dementia develops depends on where in the brain the disease is affecting. The symptoms and the impairment caused by dementia are a result of progressive damage to the brain and a loss of brain cells and connections. Alzheimer’s disease, for example, is the commonest cause of dementia. In this systematic review and meta-analysis, Tsoi and colleagues from Hong Kong aimed to assess the relative effectiveness of common cognitive tests at diagnosing dementia.ĭementia is an umbrella term for a number of different brain diseases that progressively affect a person’s ability to think and function independently.
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