Do we need yet another cognitive test? Free-Cog, a novel, hybrid, cognitive screening instrument

The dementia syndrome encompasses not only cognitive but also functional impairments. This is acknowledged in canonical definitions of dementia (DSM-IV) and major neurocognitive disorder (DSM-5).1 2 However, functional (executive) deficits are not addressed in standard cognitive screening instruments, although they may be more significant for both patients and their carers in terms of their impact on activities of daily living. Traditionally, separate scales have been used to assess cognition and executive function. Free-Cog was developed to assess both cognitive and executive function in a single instrument, hence, a ‘hybrid’ test which combines questions in both domains (accessed at https://www.gmmh.nhs.uk/free-cog).3 The former component assesses traditional measures such as orientation in time and place, memory, calculation, attention, visuospatial function, language and fluency. The latter items are assessed on the basis of responses to a series of themed questions related to activities of daily living, including social functioning, travel, self-care and safety at home. Maximum scores for ‘cognitive function’ and ‘executive function’ are 25 and 5, respectively, giving an overall composite score of 30. Higher scores indicate better function. In this way, it is similar to most other cognitive screening tests such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Mini-Addenbrooke’s Cognitive Examination (MACE). Free-Cog was initially validated in a proof-of-concept test accuracy study.3 In this index study, a cohort of 960 patients and controls was recruited from multiple memory clinics in the UK, mostly based within psychogeriatric services. The total Free-Cog score and its …