Addenbrooke’s Cognitive Examination-III

The abolition of fixed retirement means that many people will work into their late 60s or even their early 70s. Older health care workers tend to suffer from the four Ds—drink, drugs, depression and dementia [1]. Studies show negative correlations between performance on cognitive testing and job performance problems [2] or with age [3]. One study found cognitive impairment in doctors was responsible for 63% of all adverse medical events with most being preventable [4]. Detection of cognitive impairment is essential in determining any risk to patient safety and to safeguard patients by designing and implementing effective remediation programmes. Dementia UK [5] estimates that 1.3% of people aged 65–69 years have dementia rising to 2.9% for those aged 70–74 years. Lesser degrees of cognitive impairment can be more common in people at these ages, increasing demand on occupational physicians to assess older workers for possible cognitive impairment(s). Mild cognitive impairment converts to dementia at a rate of ~10% per year [6], a clinical challenge due to the variety and often dynamic nature of symptoms. There is need to determine whether cognitive impairment is present but also to establish which cognitive domains are affected in relation to skills and knowledge required by the person’s occupation [7]. Screening must be effective, cost beneficial with suitable methods and therapeutic evidence. Patients may perform poorly on formal cognitive tests for other reasons, including acute illness, pain, lethargy, sleep deprivation, medication, depression, anxiety, not wishing to engage with testing, language barriers, cultural issues and learning disability. Hence these tests form part of the overall clinical assessment and clarity is needed as to the level of detail required for screening, differential diagnosis or detailed neuropsychological analysis.