Blog 2: NHS cognitive assessment — what to expect and how to prepare
The NHS assessment pathway
Step 1 — GP screening: The GP conducts a brief cognitive screening test (typically GPCOG, 6CIT, or Mini-Cog per NICE NG97 Rec 1.2.3), orders "dementia screening bloods" (FBC, U&E, LFT, calcium, glucose/HbA1c, TSH, vitamin B12, folate), and may request an ECG.
Step 2 — Memory clinic referral: If dementia is still suspected after bloods rule out reversible causes, the GP refers to a specialist Memory Assessment Service. The appointment lasts 60–90 minutes, conducted by a nurse specialist and/or consultant psychiatrist. It includes clinical history, cognitive testing, and a questionnaire for an accompanying relative/carer. A CT head scan may be requested.
Step 3 — Four standard components (BSMHFT NHS guidance): (1) Pre-assessment counselling, (2) Assessment (history, cognitive testing, imaging), (3) Feedback, (4) Support planning.
Possible outcomes: Dementia diagnosis (with subtype), mild cognitive impairment (MCI) — transferred back to GP, no cognitive impairment — discharged, or further assessment required (neuropsychological testing, additional scans).
Specific cognitive tests used
ACE-III (Addenbrooke's Cognitive Examination III): Tests 5 domains (attention, memory, fluency, language, visuospatial) across 21 tasks. Scored out of 100, takes 15–20 minutes. Cut-off ≤88: high sensitivity for MCI (sensitivity 1.00, specificity 0.96 — Hsieh et al., 2013). Cut-off ≤82: high specificity for dementia (sensitivity 0.93, specificity 1.00). 2019 Cochrane Review (Beishon et al.) confirmed diagnostic accuracy. Free to use, unlike MMSE, and increasingly dominant in UK memory clinics.
MoCA (Montreal Cognitive Assessment): Tests 8 domains. Scored out of 30, takes ~10 minutes. Cut-off ≥26: normal cognition. <26: possible MCI (sensitivity 90%, specificity 87% — Nasreddine, 2005). <21: possible dementia. Average scores: Normal = 27.4; MCI = 22.1; Alzheimer's = 16.2. Important caveat: at cut-off <26, false-positive rate exceeds 40% in cognitively healthy people.
MMSE (Mini-Mental State Examination): Scored out of 30, takes 5–10 minutes. Scoring: 24–30 = normal; 19–23 = mild impairment; 10–18 = moderate; ≤9 = severe. Traditional dementia cut-off <24 (sensitivity 85%, specificity 90%). In Alzheimer's, MMSE declines ~2–4 points per year. Now copyrighted with charges — the ACE-III has largely replaced it in UK memory clinics.
Clock Drawing Test (CDT): Tests executive function, visuospatial ability, and motor programming. Patient draws a clock face and sets hands to a specific time. Sensitivity 87%, specificity 86%. Moderate-to-high correlation with MMSE (r = 0.30–0.77, mean 0.61). Useful for non-English speakers.
UK dementia statistics
- 982,000 people currently estimated to be living with dementia in the UK (Alzheimer's Society/Carnall Farrar, 2024). More than a third lack a formal diagnosis
- Projected to rise to 1.4 million by 2040
- By December 2024: 483,000 people aged 65+ with a formal dementia diagnosis in England (record high — GOV.UK Dementia Profile March 2025)
- 15,300 people with dementia aged under 65 in England (2024)
- In 2024: 76,894 deaths from dementia — the UK's biggest killer at 11.8% of all deaths (Alzheimer's Research UK/ONS)
- Cost of dementia to the UK: £42 billion in 2024, rising to £90 billion by 2040. 63% of costs borne by patients and families
- Per-person annual costs: Mild = £28,700; Moderate = £42,900; Severe = £80,500
- England's dementia diagnosis rate: 65.0% (mid-2024); NHS target is 66.7%
NHS waiting times for memory clinics
- 13 weeks (3+ months) average wait from GP referral to first assessment in England (2024 audit data — Alzheimer's Research UK)
- Pre-COVID (pre-2020): average wait was approximately 5 weeks
- 2022: 17.7 weeks (record high — BJPsych Open)
- NHS target: diagnosis or confirmed no diagnosis within 12 weeks of referral
- People in England's most deprived areas wait at least 2 weeks longer than those in least deprived (RCPsych National Audit of Dementia 2023/24)
NICE guidelines
NICE Guideline NG97 — "Dementia: assessment, management and support for people living with dementia and their carers." Published 20 June 2018 (replaces CG42). Last reviewed 24 October 2025. Key recommendations: Rec 1.2.3 specifies validated brief screening instruments (10-CS, 6CIT, Mini-Cog, TYM); Rec 1.2.4 states not to rule out dementia solely because of a normal test score; Rec 1.2.6 directs referral to specialist service if dementia still suspected after investigation. Also relevant: NICE NG16 on mid-life approaches to delay/prevent dementia onset (2015).
MCI prevalence
- UK Biobank study (Ritchie et al., 2025): Overall MCI prevalence 4.0% across all ages; 5.3% in individuals aged 60+
- CFAS (Cognitive Function and Ageing Studies): In UK population aged ≥65, mild dementia prevalence estimated at 3.0% in 2011 (down from 5.7% in 1991)
- Manchester Consensus on MCI (Age and Ageing, 2021): Endorsed computerised cognitive testing as a promising approach for early detection
Google SERP and People Also Ask
Page 1 for "NHS cognitive assessment what to expect": Dominated by individual NHS Trust memory clinic pages (EPUT, LPFT, HPFT, BSMHFT, BDCT) and Alzheimer's Society. No single comprehensive guide exists — a major content gap.
People Also Ask: "What happens at a memory clinic appointment?" · "How long does a memory assessment take?" · "What tests are done at a memory clinic?" · "Can you fail a memory test?" · "What is the difference between MCI and dementia?" · "How long do you wait for a memory clinic appointment?" · "Can you prepare for a cognitive assessment?" · "What happens after a dementia diagnosis?"
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