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AD8 Dementia Screening
AD8: 8-item informant interview detecting change from prior baseline. Complete with a family member or caregiver who has known the patient for ≥ 1 year.
Has this person changed in the past several years?
1. Problems with judgment (e.g., falls for scams, makes poor financial or other decisions, buys gifts inappropriate for recipients)
2. Reduced interest in hobbies or activities previously enjoyed
3. Repeats the same things over and over (questions, stories, or statements)
4. Trouble learning how to use a tool, appliance, or gadget (e.g., VCR, computer, microwave, remote control)
7. Trouble remembering appointments or commitments
8. Daily problems with thinking and/or memory
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Brief informant-based screen for cognitive change in primary care and memory clinics.
When direct cognitive testing is unreliable due to low education, language barriers, or patient resistance.
Differentiating normal ageing from early dementia in patients who appear functional on brief bedside screens.
Pre-visit screening in geriatric outpatient settings to prioritise further workup.
Key Clinical Advantage
The AD8 detects change from prior baseline — not just current function. This makes it uniquely sensitive for early and mild cognitive impairment where MMSE and Mini-Cog may still be normal.
Section 2
Formula & Logic
Scoring
Each item scored: Yes, Changed = 1 | No, No Change = 0 | N/A = 0
Total score: 0–8
Cutoff ≥ 2: Probable dementia (Se 84%, Sp 80%)
8 Domains Assessed
1. Judgment problems
Falls for scams, poor financial decisions
2. Less interest in hobbies
Reduced engagement in previously enjoyed activities
3. Repeats questions
Same question/story within short intervals
4. Can't learn new things
Difficulty with new appliances, medications, routines
5. Forgets month/year
Temporal orientation errors
6. Financial management difficulties
Trouble with bills, chequebook, finances
7. Forgets appointments
Missed or forgotten commitments
8. Daily memory/thinking problems
Consistent functional memory failures
Section 3
Pearls/Pitfalls
Who Is the Informant?
The AD8 can be completed by a spouse, adult child, or caregiver who has known the patient for ≥1 year. In the absence of a reliable informant, the patient may self-administer — but sensitivity drops significantly with patient self-report due to anosognosia in early dementia.
What the AD8 Does NOT Do
Does not establish a dementia diagnosis (informant screen only).
Does not differentiate dementia type (Alzheimer's vs. vascular vs. Lewy body).
Does not replace formal neuropsychological assessment or clinician evaluation.
Section 4
Next Steps
Management by Score
0–1: Normal
Reassure. Repeat in 12 months if clinical concern persists.
≥2: Probable Dementia
Proceed to formal cognitive testing (MoCA/MMSE), functional assessment, and dementia workup including TSH, B12, CBC, metabolic panel, and neuroimaging.
Complementary Tools
Mini-Cog
MoCA (Montreal Cognitive Assessment)
MMSE
CDR (Clinical Dementia Rating)
IQCODE
Section 5
Evidence Appraisal
Primary Reference
The AD8: a brief informant interview to detect dementia.
Galvin JE et al. • Neurology.. 2005;65(4):559–564. Derivation study; cutoff ≥2 validated against DSM-IV dementia diagnosis in 60 informant-patient pairs.
Section 6
Origins
Washington University Memory & Ageing Project
Developed by James Galvin at the Washington University Alzheimer's Disease Research Center. The AD8 was designed to fill the gap between informant-based clinical interviews (lengthy) and patient-administered screens (insensitive in early disease). Its 8 items were selected from a larger pool based on their ability to discriminate preclinical from symptomatic Alzheimer's disease in a longitudinal ageing cohort.
