What is the General Practitioner Assessment of Cognition (GPCOG)?

The General Practitioner Assessment of Cognition, or GPCOG, is a screening tool used to assess cognitive function in adults, particularly older people. GPs (General Practitioners) often use it to detect possible cognitive impairment or early dementia. The assessment is known for being short, easy to use and effective in a busy general practice setting. It provides a way for healthcare professionals to make an initial judgement about a patient’s memory and other mental abilities without the need for lengthy or complex tests.

Cognitive impairment refers to problems with thinking, memory or decision making. These changes can range from mild to severe and sometimes signal conditions such as Alzheimer’s disease or other forms of dementia. By detecting issues early, GPs can refer patients for further testing, offer support or start treatment where necessary.

The Background and Need for the GPCOG

As the population ages, there are rising numbers of people affected by dementia and other cognitive disorders. Quick and effective screening tools are now more important than ever in routine clinical care. Before the GPCOG was introduced, assessments like the Mini-Mental State Examination (MMSE) were the most commonly used tools. Unlike the MMSE, the GPCOG is free and does not require trained psychologists to score it.

The GPCOG was developed following research in both Australia and the UK, with input from GPs and patients. The goal was to produce a tool that would be practical for primary care, accurate and simple enough to encourage routine use. It now features in NICE (National Institute for Health and Care Excellence) guidelines as one of the recommended options for cognitive assessment.

The Two Main Parts of the GPCOG

The GPCOG has a structure that supports speedy, stepwise evaluation. It is split into two main components:

• Patient Section
• Informant Section

Patient Section

The initial part of the GPCOG focuses directly on the patient. It takes about four to six minutes to complete and includes simple questions and tasks. The aim here is to check the person’s memory, orientation, ability to recall recent events, and perform basic mental tasks.

Informant Section

If the patient achieves a certain score on the patient section, this may be enough to rule out significant cognitive impairment. If results are unclear, or if the patient has difficulties, the GP can use the informant section. This part involves a relative, caregiver or friend who knows the patient well. The informant answers a series of questions about changes they have noticed in the person’s everyday thinking and abilities.

Administration and Scoring

Healthcare professionals find the GPCOG quick and convenient to use within standard consultations. No specialist equipment or training is needed beyond standard medical experience.

Patient Section Tasks

This section contains six tasks:

• Time Orientation: The patient is asked about the date, including the day, month, and year.
• Name and Address Recall: The GP reads out a name and address for the patient to remember, then asks them to recall it later.
• Clock Drawing: The patient is asked to draw a clock face showing a specific time.
• Information Questions: Questions check general knowledge and reasoning (such as naming an object or counting backwards).
• Other Simple Tasks: These may involve naming objects, performing calculations, or following a series of instructions.

Each answer is scored and recorded. The maximum total score for the patient section is 9.

Informant Section Questions

If the patient scores between 5 and 8, the informant section helps gather more information, adding context to the patient’s performance.

Questions in this section cover:

• Communication (repeating things or forgetting words)
• Managing money or finances
• Handling medications
• Remembering appointments
• Finding their way around familiar places

Each item has a “Yes” or “No” answer, scored accordingly.

Interpreting the Results

Interpretation of the GPCOG is straightforward.

• Score of 8–9: Unlikely that there is a significant cognitive impairment. The patient likely does not need further assessment unless there are strong concerns.
• Score of 5–7: Possible problems. The informant section should be completed before making any decisions.
• Score of 0–4: Suggests likely cognitive impairment. The GP may refer for more specialist memory assessment, investigation or support.

The final decision always depends on clinical context. The GPCOG is not a diagnosis tool—rather, it signals when further testing is needed.

Benefits of Using the GPCOG

The GPCOG outcomes provide valuable early evidence for clinicians and families. Its advantages include:

• Very quick to use (less than 10 minutes)
• No cost or special licensing
• Reliable for people from different cultural backgrounds, as it avoids complex language
• Suitable for people with mild sight or hearing difficulties
• Suitable for repeated use over time to monitor change
• Validated through clinical studies

Because the test can include input from an informant, it covers a wider picture of daily life function compared to many tests that focus solely on the patient’s direct performance.

Limitations and Things to Bear in Mind

No cognitive assessment tool is perfect. The GPCOG, while useful, has some things to consider:

• It is a screening tool, not a full diagnostic test.
• Results may be influenced by factors such as education level, language familiarity or sensory impairments.
• It may be less accurate for people with severe communication problems or those who are very unwell.

The GP will look at the assessment results in context, drawing on their knowledge of the patient’s history and current symptoms. It is only one piece of the puzzle.

Who Should Have a GPCOG Assessment?

GPs usually offer the GPCOG to people who:

• Are concerned about their memory
• Have family members worried about forgetfulness or confusion
• Have started to show changes in behaviour, personality, communication or daily function
• Are over the age of 65, since the risk of dementia increases with age

Some GPs may use the GPCOG to check on people who have medical risks for cognitive impairment, such as diabetes, stroke or long-term mental health conditions.

Comparison with Other Assessment Tools

A number of tools are available in the UK for cognitive screening. These include:

• Mini-Mental State Examination (MMSE)
• 6-Item Cognitive Impairment Test (6CIT)
• Montreal Cognitive Assessment (MoCA)
• Addenbrooke’s Cognitive Examination (ACE-III)

The GPCOG stands out for its speed, simplicity and ease of use in the GP surgery setting. Clinical studies show that its performance matches up well with longer tests, and the GPCOG is less likely to be biased by the patient’s education or cultural background.

Training and Resources Available

Many NHS resources offer printable GPCOG forms. These come with clear instructions for both the patient and informant sections. Online videos, training modules and guides are available to help healthcare professionals feel confident in using the assessment.

Support from memory clinics, dementia helplines and Alzheimer’s organisations means that patients with worrying GPCOG scores can be signposted quickly to additional help.

The Role of the Informant

The informant’s perspective helps provide background that may not be visible in a one-off appointment. Family, friends or carers may spot day-to-day changes in function, such as increased forgetfulness, getting lost, missing medications or struggling with bills.

Key things an informant might notice:

• Repetition in conversation
• Losing track of recent events
• Difficulty following instructions
• Changes in social interaction
• Struggles with personal safety or finances

This “collateral history” supports the clinical picture alongside test results.

Supporting the Patient after the GPCOG

After the GPCOG has been used, support options might include:

• Referral to a memory clinic for further assessment
• Offering practical help at home (social services, occupational therapy)
• Starting medication (in some cases)
• Connecting families with dementia support groups

Early identification with the GPCOG can encourage planning for the future, ensure patients and carers feel heard, and guide people to local or national support.

The Impact of Early Detection

Detecting memory problems at an early stage allows people to access advice, organise their affairs, and put plans in place. Timely intervention can slow progression of some conditions or help manage symptoms more effectively.

GPs rely on simple, clear and effective tools like the GPCOG to provide the best care possible for patients in their surgeries. By catching warning signs early, they help people stay independent and supported for as long as possible.

Final Thoughts

The General Practitioner Assessment of Cognition is now a core part of British primary care. The test is practical, reliable, and fits easily into ordinary practice. For anyone worried about changes in memory or thinking, the GPCOG gives GPs a tool to begin appropriate support, helping both patients and their families approach cognitive changes with dignity and understanding.