How the GPCOG Screening Tool Is Used to Screen for Dementia

GPCOG stands for the General Practitioner assessment of COGnition. The GPCOG is a short screening tool for dementia that was developed by Henry Brodaty, Dimity Pond, Nicola Kemp, Georgina Luscombe, Louise Harding, Karen Berman, and Felicia Huppert.

The GPCOG is one of three screening tools recommended by the Alzheimer's Association for use at the Medicare annual wellness visit. The other two screenings are the Memory Impairment Screen and the Mini-Cog.

When the GPCOG is administered to "Fred," he is asked to perform the following components:

1. Repeat and remember the following name and address. "John Brown, 42 West Street, Kensington." Fred is told to remember the name and address because in a few minutes he will be asked to recall it. He is allowed to repeat it four times.
2. Fred is asked to state today's date.
3. He is given a blank page and asked to make a clock drawing with all of the numbers drawn correctly on the face.
4. Fred 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 Fred to tell her something specific that has happened in the news in the last week.
6. Lastly, Fred is asked to recall the name and address from the beginning of the test.

Fred is given one point for the correct date. While other tests allow for a "close" answer, the GPCOG requires the exact date in order to get credit.

He receives one point for correctly drawing the clock which must include accurate placement of the numbers on the face. He also receives one point for correctly placing the hands to show 10 minutes past 11 o'clock.

If Fred can tell you something specific from recent news, he receives one point.

In the name and address recall section, Fred receives one point for each of the following answers:

• John
• Brown
• 42
• West (St)
• Kensington

If Fred scores 9 points (the maximum total points), no more assessment is needed. A score of 5-8 indicates that more information is needed and the test administrator is asked to proceed with a second section of the test where a family member or caregiver answers questions about Fred. This section is called the "Informant Interview." If Fred scores between 0-4, it's likely that his cognition is impaired.

In this follow-up section of the GPCOG, a caregiver or family member is asked six questions about Fred. These questions ask if Fred is having more difficulty than he used to 5-10 years ago with the following tasks: recent memory, memory for conversations held a few days ago, word-finding ability, handling finances, medication management and ability to handle transportation needs.

If the informant indicates a decline in 3 or more of these areas, cognitive impairment is likely, according to the GPCOG.

The GPCOG has been shown to be effective in identifying impaired cognition. The research compared the GPCOG to the well-known Mini Mental State Exam and found that it performed as well as or better than the MMSE.

Pros

• The GPCOG is copyrighted by the University of New South Wales but clinical use is free.
• The test is brief. It takes between two to five minutes to administer the GPCOG.
• The GPCOG does not require extensive training to administer.
• Education level has little effect on the accuracy of the GPCOG. It should produce accurate results whether someone only completed 6th grade or is a college graduate.
• Multiple versions in different languages are available online.

Cons

• Although it has been translated into several languages, research is lacking on how different cultures and languages impact the test's results.
• This test requires the physical ability to write/draw.

Remember that the GPCOG is a screening tool, not a definitive diagnostic tool. It can indicate whether or not more testing is needed, but a physician should be consulted to conduct further testing. There are other, sometimes reversible, causes of memory loss that can be identified by medical tests including normal pressure hydrocephalus, vitamin B12 deficiency and the interactions of medications.