To demonstrate the clinical and diagnostic insights provided through administration of a simple pen and paper exercise as part of Geriatric assessment and what this offers to understanding cognitive impairment in our patients.

A retrospective file review was conducted to select illustrative case studies of de-identified patients who presented for Geriatric assessment. Each patient had been administered a brief selection of visual tasks, in addition to the Mini-Mental State Examination (MMSE) and medical/radiological investigations required to inform diagnosis. The visual tasks of interest in this paper consisted of copying a 3D box, drawing a clock face, and drawing ‘ramparts’.

Comparisons of results were made across numbers of different clinical conditions, providing qualitative insights to inform diagnosis. Results varied across different conditions, as will be demonstrated in this paper. Results on these tasks were sometimes surprising, and unrelated to verbal testing. Examples will be presented of task performances which informed diagnoses such as Posterior Cortical Atrophy.

The addition of these simple pen and paper tasks to the standard MMSE can help inform clinical diagnostic decisions. The low verbal demands of these tasks facilitates examination of patients with impaired language functioning. The tests are quick and repeatable, and patients are generally willing to attempt this even when they are uncooperative with further questioning. This approach adds little time commitment but can offer valuable insights, particularly into executive, visuospatial and constructional abilities.