Brief structured questionnaires can also help determine whether a diagnostic evaluation for dementia is needed.

They are used to gather information from patients as well as family members and other knowledgeable informants about any changes to cognition and function, along with any neuropsychiatric symptoms that the patient may be experiencing. Although not diagnostic in nature, these instruments can be helpful tools for increasing accuracy of information collected before undertaking a more comprehensive evaluation.

Obtain perceptions of family members or other individuals who know the person well.

The Ascertain Dementia 8-Item Informant Questionnaire (AD8)

The AD8 takes about 3 minutes to administer and is sensitive to early signs of cognitive impairment (Galvin, 2005; Galvin, 2007). It yields a score from 0 to 8 based on responses to 8 questions that address memory, apathy, executive function, orientation, or general problems with memory or thinking over the past several years (Galvin, 2005). In addition to being used by knowledgeable informants, it is the only structured assessment that can also be used for individual self-report.

Informant-Based Behavioral Pathology in Alzheimer’s Disease (BEHAVE-AD) Rating Scale

The BEHAVE-AD has 25 questions that collect information about observable neuropsychiatric symptoms (e.g., dementia-related psychosis, aggression) that have been observed in the past 2 weeks by knowledgeable informants. It takes about 20 minutes to administer. Because the test asks about symptoms observed in the past 2 weeks, it does not require long-term recall on the part of the family member or knowledgeable informant. 

The Short Form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) 

The short IQCODE or IQCODE 16 screening tool asks the family member or knowledgeable informant to reflect on any changes that may have occurred in the person in the last 10 years. This assessment has 16 questions and can be completed in 10 to 15 minutes. Information from this assessment may be combined with information from the full IQCODE and the Mini-Mental State Examination (which will be discussed in the Evaluate section).

Agitation in Alzheimer’s Screener for Caregivers

The Agitation in Alzheimer’s Screener for Caregivers (AASC™) is a brief screening tool introduced at the GSA 2023 Annual Scientific Meeting by Clevenger and colleagues. The AASC™ is based on the International Psychogeriatric Association (IPA) consensus definition for agitation in cognitive disorders and is designed to assist caregivers (including family caregivers) in recognizing agitation-associated behaviors in patients with Alzheimer’s disease. When agitation is detected, care teams can use the GSA tool, Agitation in Alzheimer's Disease: A Decision Tree for Healthcare Providers, developed by Grossberg and colleagues to guide care planning.

Consider obtaining individual perceptions.

Some individuals have subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss. Although 1 in 9 people aged 45 years and older experience SCD, fewer than half discuss it with their health care teams (National Association of Chronic Disease Directors, 2018). Individuals’ concerns about their memory or thinking should not be discounted, even if there is no obvious impairment, and additional evaluations should be considered.

Resources

Resources to discuss SCD with patients include an infographic from the CDC and worksheets for patients and family members/knowledgeable informants from the Alzheimer’s Association based on the organization’s widely disseminated 10 Warning Signs and Symptoms of Alzheimer’s Disease. These resources can help begin to guide individuals on how to observe symptoms.

Research

Research suggests the AD8 is more accurate in detecting subtle signs of cognitive decline when completed by familiar family or friends than when completed by individuals with possible cognitive impairment (Dong, 2013). AD8 self-ratings can provide useful information about cognitive ability and are especially valuable for increasing understanding of individuals’ perceptions of their own cognition. 

Healthcare Teams

Health care team members can ask individuals to use a self-report questionnaire such as the AD8 to elicit patient concerns and identify SCD. This may be especially helpful when family members or friends are not available to provide reliable information about possible cognitive changes.


Assess | Approaches to Implement

Strategies to Assess for Cognitive Impairment | Brief Cognitive Tests | Structured Assessment Instruments | Case Study | Assess References