GPCOG Screening Tool for Dementia

The General Practitioner Assessment of Cognition (GPCOG) is a short screening tool for dementia. The test includes a patient assessment and a caregiver interview. It takes about four to six minutes to complete. The tool was developed in 2002 by Henry Brodaty and colleagues at Prince of Wales Hospital in Australia.

The Alzheimer's Association recommends screening for cognitive impairment at Medicare annual wellness visits. It recommends using the GPCOG, Memory Impairment Screen (MIS), or the Mini-Cog for this purpose.

This article provides an overview of the GPCOG, including what to expect, how it's scored, and how it compares to other screening tools.

Tasks in the GPCOG

The first section of the GPCOG is a brief patient assessment, which takes about four minutes. Depending on the score the patient receives for this section, the test may also call for a caregiver to complete an informant interview, adding an additional two minutes to the test.

The patient assessment portion of the GPCOG involves five components:

1. The test administrator or healthcare provider tells the patient to repeat and remember a name and address (e.g., John Brown, 42 West Street, Kensington) and recall it in a few minutes.
2. The patient is asked to state today's date.
3. The test administrator provides a blank page with a circle and asks the patient to make a clock drawing with all of the numbers drawn correctly on the face of the clock.
4. The patient is then asked to draw in the clock's hands so that it reads 10 minutes past 11 o'clock.
5. The test administrator asks the patient to describe something specific that has happened in the news in the last week.

Common errors include drawing the hands the wrong size or difficulty planning the overall placement of numbers. A "stimulus bound" dysexecutive response of pointing the hands impulsively at 10 and 11 (instead of 2 and 11) is also not uncommon. These errors are associated with a decline in executive function, which is a person's ability to think and plan.

Scoring

The total score for the patient assessment part of the GPCOG is nine points.

In the name and address recall section, the patient receives one point for correctly providing each of the answers (for a score of up to five points).

• First name
• Last name
• Street number
• Street name
• City name

The patient receives one point for saying the correct date. While other tests allow for a close answer, the GPCOG requires the exact date in order to get credit.

One point is given for correctly drawing the clock, which must include accurate placement of the numbers on the face. They receive one point for correctly drawing the hands of the clock to show 10 minutes past 11 o'clock.

Finally, the patient receives one point for telling the administrator something specific from recent news in the past week.

Score Interpretation and Next Steps

For the healthcare provider, the test is used as a screening tool, which isn't 100% accurate at detecting significant problems or at identifying them as definite cognitive problems. Low scores could be a result of effort, language barriers, or temporary medical issues like fatigue or an infection.

Follow up can be based on scores, as well as the patient's medical history and overall function:

• No further assessment is needed if the patient scores the maximum total of nine points.
• A score of five to eight indicates more information is required. The test administrator will then continue to the second section of the test. They will ask a family member or caregiver some questions about the patient. This section is called the "Informant Interview."
• If the patient scores between zero to four points, the exam suggests that they may be cognitively impaired. An informant interview isn't required, but the healthcare provider may want to perform additional diagnostic tests.

Informant Interview

In this follow-up section of the GPCOG, the test administrator asks a caregiver or family member if the patient has more difficulty than they used to five to ten years ago with the following tasks:

• Recent memory
• Memory for conversations held a few days ago
• Word-finding ability
• Handling finances
• Medication management
• Ability to handle transportation needs

If the informant indicates a decline in three or more of these areas, the patient likely has cognitive impairment. From there, the healthcare provider may suggest more definitive tests to diagnose dementia.

Pros and Cons of the GPCOG

The GPCOG has several benefits for healthcare providers and patients. But it also has a few drawbacks.

Advantages

The test is free. University of New South Wales copyrights the GPCOG, but allows free access for clinical use. Administrators can print the test or use the web version.

The test is brief. It takes between two to five minutes to administer the GPCOG. It also doesn't require the administrator to have extensive training.

Patient education level has little effect on the accuracy of the GPCOG. It should produce accurate results whether someone has only completed sixth grade or is a college graduate. Additionally, the test is available in different languages online.

Disadvantages

Although the GPCOG has been translated into several languages, there isn't enough research on how different cultures and languages might affect the test's results.

This test requires the physical ability to write or draw. If the patient isn't able to hold a pen or pencil, they are unable to complete the clock drawing portion of the test.

Summary

GPCOG stands for General Practitioner assessment of Cognition. It's an effective, quick, and accurate screening tool for dementia. The test is simple to administer to patients to test for cognitive impairment and is scored based on the accuracy of the answers.

A Word From Verywell

Remember that the GPCOG is a screening tool, not a definitive diagnosis. It can indicate if more testing is needed, but you should consult a healthcare provider for further tests. There are other, sometimes reversible, causes of memory loss that medical tests can confirm or rule out.