AAC Cognitive Assessment & Screening 3 — Questions and Answers
Question 1: Which of the following best explains why depression can complicate cognitive screening results?
- Depression has no effect on cognitive performance
- Depression can cause pseudodementia, producing cognitive test scores that mimic dementia (Correct answer)
- Depressed individuals always score higher due to increased concentration
- Depression only affects language domains
Correct answer: Depression can cause pseudodementia, producing cognitive test scores that mimic dementia
Depression can cause pseudodementia — a reversible cognitive impairment — making it essential to assess mood before interpreting low cognitive screening scores.
Question 2: The Alzheimer's Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) is most commonly used in:
- Routine primary care screening
- Clinical trials to measure treatment response (Correct answer)
- Emergency department triage
- School-based learning assessments
Correct answer: Clinical trials to measure treatment response
The ADAS-Cog is the standard outcome measure in Alzheimer's clinical trials because it is sensitive to change over time across multiple cognitive domains.
Question 3: A caregiver reports that their mother was doing well on last year's MMSE but scored 4 points lower this year. What does this change most suggest?
- Normal aging
- Clinically significant cognitive decline (Correct answer)
- Test-retest unreliability only
- Improvement in one domain offsetting loss in another
Correct answer: Clinically significant cognitive decline
A 4-point decline on the MMSE over one year exceeds normal aging variation and typically signals meaningful clinical deterioration.
Question 4: Which cognitive domain is typically FIRST affected in typical Alzheimer's disease?
- Language
- Visuospatial skills
- Episodic memory (Correct answer)
- Executive function
Correct answer: Episodic memory
Episodic memory — particularly the ability to encode and recall new information — is classically the first domain impaired in typical Alzheimer's disease.
Question 5: When using the MMSE, which item directly tests ORIENTATION to place?
- What is today's date?
- What state/county/town are we in? (Correct answer)
- Repeat these three words.
- Spell 'WORLD' backwards.
Correct answer: What state/county/town are we in?
The MMSE includes five place orientation questions asking about country, state, city, building, and floor.
Question 6: A validated informant-based questionnaire used to assess functional and cognitive decline from a caregiver's perspective is the:
- PHQ-9
- Functional Activities Questionnaire (FAQ) (Correct answer)
- GAD-7
- Beck Depression Inventory
Correct answer: Functional Activities Questionnaire (FAQ)
The FAQ asks informants to rate the patient's ability to perform instrumental activities of daily living, providing real-world functional context alongside cognitive scores.
Question 7: Which of the following populations requires the most adjustment or caution when interpreting standard cognitive screening scores?
- College graduates aged 65–70
- Individuals with limited English proficiency or low literacy (Correct answer)
- Patients with well-controlled hypertension
- People who exercise regularly
Correct answer: Individuals with limited English proficiency or low literacy
Standard cognitive tools are often normed on English-speaking, educated populations, making scores less valid for individuals with limited English proficiency or low literacy.
AAC Cognitive Assessment & Screening 3
Which of the following best explains why depression can complicate cognitive screening results?