Two assessment tools that are appropriate for primary care are; GPCOG and AUA Symptom Index for BHP and the Disease-
Specific Quality-of-Life Question.
Tool #1: GPCOG
Explain the purpose of the tool:
The GPCOG is a tool that is reliable, valid and efficient instrument to screen for dementia specifically in a primary care setting
(More about the GPCOG, 2016). GPCOG stands for the General Practitioner assessment of COGnition. This screening tool is
very effective, and it only takes 4 minutes to administer the patient assessment and 2 minutes to interview the caregiver, which
is nice when time is limited like at a PCP office appointment. Reviews of dementia screening tools for the primary care setting
recommend the use of the GPCOG since the GPCOG score is not influenced by the cultural and linguistic background of a
person making it an invaluable screening tool especially in multicultural patient settings (More about the GPCOG, 2016). This
tool has also been translated to many languages and is used in many countries across the globe.
Scoring guidelines:
Firstly, the GPCOG website allows the PCP to impute the patients answer and it calculated the score online instantly. The
provider will read out each question to the patient and record the response.
Question # 1,
I am going to give you a name and address. After I have said it, I want you to repeat it. Remember this name and address
because I am going to ask you to tell it to me again in a few minutes: John Brown, 42 West Street, Kensington.
Question # 2,
What is the date (today)?
Question # 3,
Clock drawing: use a blank page have the patient mark in all the numbers to indicate the hours of a clock. Then mark in hands to
show 10 minutes past eleven o’clock.
Ask the patient to tell you something that happened in the news recently (I n the last week. If a general answer is given,
e.g. “war”, “lot of rain”, ask for details.
Question # 5,
Ask the patient to recall What was the name and address that was asked in the first question. Each part of the name /
address is scored.
To get a total score, add the number of items answered correctly the score is out of 9. If patient scores 9, no significant cognitive
impairment and further testing not necessary. If patient scores 5-8, more information required. Proceed with Step 2, informant
section. If patient scores 0-4, cognitive impairment is indicated. Conduct standard investigations (More about the GPCOG,
2016).
The next part involves asking a family member 6 questions and having them compare it to how the patient was 5 – 10 years ago.
1. Does the patient have more trouble remembering things that have happened recently than s/he used to?
2. Does he or she have more trouble recalling conversations a few days later?
3. When speaking, does the patient have more difficulty in finding the right word or tend to use the wrong words more often?
4. Is the patient less able to manage money and financial affairs (e.g. paying bills, budgeting)?
5. Is the patient less able to manage his or her medication independently?
6. Does the patient need more assistance with transport (either private or public)?
If patient scores 0-3 out of 6, cognitive impairment is indicated and conducting standard investigations is warranted (More about
the GPCOG, 2016).
How you apply the assessment in practice:
This test is very easy and quick to complete. I believe it will be very useful to my practice as a future family nurse practitioner.
Many older patients often come in and mention that they are worried they a loosing their memory. This tool is useful in
determining if further testing is necessary. Additionally, the GPCOG is one of three screening tools recommended by the
Alzheimer's Association for use at the Medicare annual wellness visit.
Tool #2: The AUA Symptom Index for BHP and the Disease-Specific Quality-of-Life Question
Explain the purpose of the tool:
A symptom index for benign prostatic hyperplasia (BPH) was developed and validated by a multidisciplinary measurement
committee of the American Urological Association (AUA). This index is both valid and reliable in identifying the need to treat
patients with benign prostatic hyperplasia (BPH) and in monitoring their response to therapy (The AUA Symptom Index for BHP
and the Disease-Specific Quality-of-Life Question, 2009).
Scoring guidelines:
Ask the patient to rate their BPH Symptom from 0-5 with 0 = Not at all, 1 = Less than 1 time in 5, 2 = Less than half the time, 3 =
About half the time 4 = More than half the time, and 5 = Almost always.
Questions:
1. Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished
urinating?
2. Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating?
3. Over the past month, how often have you found you stopped and started again several times when you urinated?
4. Over the past month, how often have you found it difficult to postpone urination?
5. Over the past month, how often have you had a weak urinary stream?
6. Over the past month, how often have you had to push or strain to begin urination?
7. Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until
the time you got up in the morning?
A score of 0-7: Mild symptoms, 8-19: Moderate symptoms, and 20-35: Severe symptoms (The AUA Symptom Index for BHP and
the Disease-Specific Quality-of-Life Question, 2009).
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