PL-5.2 Evaluation of cognitive impairment in the office: for whom? when? And how?

Fadi Massoud, Canada

Internist-Geriatrician
Centre Hospitalier Charles LeMoyne

Questions Submitted

  • A MOCA 24/30 in a functional 75 years old complaining of forgetfullness, will this be considered mild neurocognitive disorder. What are the limiting factors of MMSE and MOCA? What could overshoot the result?
    Response: That could be mild NCD - Function is the main element to differentiate mild vs major - many limiting factors for both tests: education, language barrier, age, hearing impairment, pbs with eyesight,etc.

  • Do you recommend MOCA vs MMSE? Does your recommendation differ if for diagnosis versus monitoring?
    Response: This depends on driving history. Follow-up could be enough, otherwise on-road testing.

  • Any benefit for statin, in pt with no other statin indication, to prevent progression?
    Response: No indication in primary prevention in that context.

  • How to deal with patients (with early disease/ mild cognitive impairment) ask for MAID?
    Response: As you know, individuals cannot yet ask for "anticipated" MAID. If they fulfill criteria for MAID (90 days, significant suffering, non-treatable condition, etc.), then you can do the request.

  • If Mini-Cog is normal, is it enough to stop there?
    Response: Yes, unless there are other worrisome complaints.

Objectives

1.Determine what is benign forgetfulness and distinguish from mild cognitive impairment and major neurocognitive disorder

2.Use and interpret standardized screening tests judiciously

3.Develop a timely and strategic approach to clinical diagnosis

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