Geriatric Cognitive Function Assessment for Physiotherapists

Lecture outcomes

• Understand the importance of early cognitive screening in older adults

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• Recognize the role of physiotherapists in identifying and managing cognitive impairments

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• Describe the prevalence and burden of dementia, especially in South Asia and Sri Lanka

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• Identify and differentiate commonly used cognitive screening tools (e.g., MMSE, MoCA, Mini-Cog, TMT, ACE)

Importance of Cognitive Assessment in Geriatrics

1. Early detection of cognitive decline
2. Plan treatments based on the individual’s cognitive abilities
3. Prevention of complications associated with cognitive impairments
4. Enhance compliance with rehabilitative exercises
5. Support caregivers in communication techniques and safety measures
6. Monitor the progression and improvement of cognitive functions

Role of the Physiotherapist in Early Identification and Management of Cognitive Impairments

• Cognitive screening during routine assessments
• Integrating cognitive elements into the treatment plan
• Refer identified cognitively impaired patients to specialists

Prevalence of Cognitive Impairment and Dementia in Older Adults

• Global Dementia Prevalence (2023)
• Over 55 million people are living with dementia
• Nearly 10 million new cases annually
• The global prevalence in people aged 60 and above is estimated to be around 5–8%
• Higher Prevalence in South Asia Compared to Global Averages
• South Asian countries generally show higher prevalence rates due to underdiagnosis, limited awareness, and fewer healthcare resources
• A meta-analysis estimated dementia prevalence in South Asia to be 6.5–10% in adults over 60

• Sri Lanka’s Dementia Prevalence Exceeds Regional Averages
• Sri Lanka shows dementia prevalence rates of around 11.8% in some studies
• Faster Aging in Sri Lanka Elevates Risk
• Sri Lanka is among the fastest-aging countries in South Asia
• By 2050, nearly one in four Sri Lankans will be over 60
• This will significantly increase the national dementia burden compared to many other low- and middle-income countries

Image source: https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.summerfieldredlands.com%2Funderstanding-the-umbrella-of-dementia%2F&psig=AOvVaw1Odsg5Sgh0waD1revDsBYW&ust=1759721692163000&source=images&cd=vfe&opi=89978449&ved=0CBUQjRxqFwoTCIiQ86SQjJADFQAAAAAdAAAAABAE

Image source: https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.alzheimersresearchuk.org%2Fnews%2Fnearly-half-of-global-dementia-cases-could-be-prevented-or-delayed-by-addressing-14-health-and-lifestyle-factors-says-new-report%2F&psig=AOvVaw1TSMaf9Sut6Cz4WJJBBEUt&ust=1759721754784000&source=images&cd=vfe&opi=89978449&ved=0CBUQjRxqFwoTCNDmnsKQjJADFQAAAAAdAAAAABAE

Image source: https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.alzint.org%2Fresource%2Fwarning-signs-of-dementia-infographic%2F&psig=AOvVaw02Pk6XqicWVsnNcWHY7KVl&ust=1759721823727000&source=images&cd=vfe&opi=89978449&ved=0CBUQjRxqFwoTCJCxteOQjJADFQAAAAAdAAAAABAE

Image source: https://www.nccdp.org/understanding-the-seven-stages-of-dementia-a-guide-for-caregivers-and-professionals/

Principles of Cognitive Assessment

1. Holistic Approach
• Assess multiple cognitive domains
• Memory, attention, language, executive function, visuospatial and spatio-temporal orientation abilities
2. Use of standardized tools
• Employ validated screening instruments to ensure consistency and reliability
3. Consideration of baseline function and education
• Interpret results in the context of the individual’s premorbid abilities, education level, and cultural background to avoid misdiagnosis due to normal aging or low literacy
4. Early detection and monitoring
• Aim for early identification of cognitive decline and track changes over time
5. Incorporation of functional impact
• Assess how cognitive changes affect daily activities

Cognitive Screening Tools Overview

• Choose tools with high sensitivity and specificity
• Tools for use in clinical practice
1. Min-Cog Assessment Tool
2. Montreal Cognitive Assessment (MoCA)
3. Mini-Mental State Examination (MMSE)
4. Trail Making Test (TMT) Part A & B
5. Addenbrooke’s Cognitive Examination (ACE)
• These tools can be effectively used in outpatient clinics, inpatient wards, rehabilitation centers, and even during home visits

Min-Cog Assessment Tool

Montreal Cognitive Assessment (MoCA)

Mini-Mental State Examination (MMSE)�

PDF source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://muhc.ca/sites/default/files/micro/m-PT-OT/OT/Mini-Mental-State-Exam-(MMSE).pdf

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Trail Making Test (TMT) Part A & B

PDF source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://eatspeakthink.com/wp-content/uploads/2018/06/IowaTrailMaking.pdf

Addenbrooke’s Cognitive Examination (ACE)

PDF Source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://rightdecisions.scot.nhs.uk/media/ztyhfgfj/ace-iii-2017-uk-version-a.pdf

Addenbrooke’s Cognitive Examination (ACE)

PDF Source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://rightdecisions.scot.nhs.uk/media/ztyhfgfj/ace-iii-2017-uk-version-a.pdf

Addenbrooke’s Cognitive Examination (ACE)

PDF Source: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://rightdecisions.scot.nhs.uk/media/ztyhfgfj/ace-iii-2017-uk-version-a.pdf

Take home message

• Cognitive decline is common in aging and early detection is vital

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• Physiotherapists play a key role in screening and supporting patients with cognitive impairment

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• Use validated tools tailored to the individual’s background

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• Early intervention enhances treatment outcomes, safety, and caregiver support

References

• Livingston G, et al. (2020). Dementia prevention, intervention, and care: 2020 report of the LancetCommission. The Lancet, 396(10248), 413-446.
• Ngandu T, et al. (2015). A 2 year multidomain intervention of diet, exercise, cognitive training, andvascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER):a randomised controlled trial. The Lancet, 385(9984), 2255-2263.
• Borson, S., Scanlan, J. M., Chen, P., & Ganguli, M. (2003). The Mini-Cog as a screen for dementia: Validation in a population-based sample. Journal of the American Geriatrics Society, 51(10), 1451–1454. https://doi.org/10.1046/j.1532-5415.2003.51465.x
• Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., ... & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
• Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6
• Reitan, R. M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8(3), 271–276. https://doi.org/10.2466/pms.1958.8.3.271
• Mathuranath, P. S., Nestor, P. J., Berrios, G. E., Rakowicz, W., & Hodges, J. R. (2000). A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology, 55(11), 1613–1620. https://doi.org/10.1212/WNL.55.11.1613

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