Researchers set out to evaluate the efficacy of three prominent cognitive exams used to screen people for FTD and other dementias in a recent study published in the medical journal Alzheimer’s & Dementia.

The study authors reviewed literature examining three “second-tier” cognitive exams to gauge their effectiveness, evaluating the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Saint Louis University Mental Status (SLUMS) exam. Second-tier screening tests are a type of cognitive exam physicians use to check multiple cognitive domains (such as attention, language, or orientation). Each test is a “sum score” exam grading participants on a scale of 0-30, with 30 representing no cognitive impairments.

While relatively straightforward and brief, taking only 10-15 minutes on average, these exams vary in evaluating certain domains and often skip certain domains entirely. For example, one edition of the MMSE assigns eight points to language, with its focus spread across comprehension, reading, writing, and other sub-domains. The SLUMS exam, however, gives a single point to comprehension and ignores all other aspects of language.

Because certain domains are being excluded, researchers write that these exams leave physicians unable to properly evaluate deficits in certain areas. This exclusion can result in misdiagnosis or a neurodegenerative condition being missed in its earlier, less apparent stages.

The researchers noted several key weaknesses for each test:

• The MMSE did not test for attention- or executive-based deficits. It barely tested for visuospatial deficiencies and only paid slightly more attention to memory deficits. While the exam tests for the ability to complete a three-step task, it has no other measures for one- or two-step tasks if someone cannot complete the initial three steps.
• MoCA tested for attention, though the authors found it was non-demanding for college graduates, making it less helpful for higher-education participants. Despite testing for difficulties registering new information, it did not score for these registration deficits. When testing for language, MoCA did not score comprehension.
• SLUMS, like MoCA, tests for registration but assigns no score based on a participant’s response. While SLUMS tests for attention, the weight of the domain score was lower than the MMSE. Only comprehension is checked in language and is only worth a single point toward a score.

While there are cognitive exams that fully encompass all domains, these tests can take several hours and aren’t always accessible. However, the study authors highlighted domain-specific cognitive exams as a more suitable tool for evaluating dementia-related deficits.

Domain-specific exams aren’t much longer than broad exams like the MMSE or MoCA, only taking 10-30 minutes. The exams not only account for basic foundational domains of cognition, such as the ability to register new information, but can also account for higher-level functions like memory.

Because domain-specific exams can account for deficits more accurately, they are more helpful in helping physicians to educate families. For example, a deficiency in a specific domain considered moderate or severe will allow a physician to warn family members of impending difficulties with certain activities of daily living so they can prepare sooner.

Are you curious about cognitive exams or FTD diagnosis in general? Reach out to AFTD’s HelpLine for help with any concerns you might have – contact the helpline at 1-866-507-7222 or info@theaftd.org.

Interested in learning more about research on advancing diagnostic tools for FTD? Click here to read about a study on machine-learning algorithms and their ability to recognize FTD and other dementias.