Cognition and mental capacity – what’s the difference?

Cognition and mental capacity – what’s the difference?

Mental capacity and cognitionIs a mental capacity assessment needed when assessing NHS Continuing Healthcare eligibility?

Tip no. 25 in our series of 27 top tips on NHS Continuing Healthcare…

The different tests, assessments and abbreviations that crop up when you’re going through the NHS Continuing Healthcare assessment process can be confusing.

This is particularly true when it comes to a person’s cognitive, memory and decision making abilities.

Here’s a quick at-a-glance overview of cognition and mental capacity – and the difference between them:


In an NHS Continuing Healthcare assessment, one of the things assessed is a person’s cognition. Cognition relates to a number of things, including a person’s degree of confusion, disorientation and/or ability to carry out basic or more complex tasks. It also relates to a person’s ability to make decisions and choices for themselves, their memory and their awareness of risk and of their own needs.

When NHS Continuing Healthcare assessors are completing the Cognition section of the Decision Support Tool document, they should look at all these things (and more, if relevant). The results of any memory tests will also be relevant here.

So cognition in this context looks at a person’s general cognitive state. Now let’s look at mental capacity…

Mental capacity

Unlike a general assessment of cognition, a mental capacity assessment relates to a person’s ‘capacity’ to make a specific decision about a specific thing at a specific moment in time.

For example, a person might have a mental capacity assessment to address the specific question of whether they want to return home after discharge from hospital – or whether they’d feel safer in a care home. This mental capacity assessment would measure their capacity to make that decision at that particular time.

So a mental capacity assessment is not an assessment of a person’s general cognitive state.

Feedback from families suggests that many people working within the health and care system don’t necessarily understand the difference between cognition and mental capacity. Some families are even told that if their relative does badly in a memory test, then the care authorities will make all subsequent decisions on that person’s behalf. This is totally flawed:

A mental capacity assessment and a memory test are two very different things.

What’s more, a poor result in a memory test doesn’t give the care authorities the automatic right to subsequently act on that person’s behalf.

Read more here: Mental Capacity Assessments – when should you have one?

Read about powers of attorney here

You’ll find lots more tips and information about NHS Continuing Healthcare on our Frequently Asked Questions page

Tip no. 24: What is a joint package of care?

Tip no. 26: “Care is routine” – misleading NHS Continuing Healthcare information

You don’t have to fight this battle alone

Fighting a Continuing Healthcare funding battle alone can feel daunting. If you need to talk to someone about your case, read more here.


  1. Tracey Murphy 2 years ago

    Our family have been sent a decision support tool to complete for our mother. albeit, we have 3 days to complete once we have seen her consultant. The document states June 2016 (amended) in the body of the front sheet, but with July 2018 at the footer.

    when i search the internet, the document sent is clearly out of date, the internet shows newly published one dated March 18. does anyone have any advise on this

    • Care to be Different 2 years ago

      The CCGs are obliged to use the new DST from October 2018 but until then the old one can still be used.

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