Self administered cognitive screening test (TYM) for detection of Alzheimer's disease: cross sectional study

Abstract

Objective To evaluate a cognitive test, the TYM (“test your memory”), in the detection of Alzheimer’s disease.Design Cross sectional study.Setting Outpatient departments in three hospitals, including a memory clinic.Participants 540 control participants aged 18-95 and 139 patients attending a memory clinic with dementia/amnestic mild cognitive impairment.Intervention Cognitive test designed to use minimal operator time and to be suitable for non-specialist use.Main outcome measures Performance of normal controls on the TYM. Performance of patients with Alzheimer’s disease on the TYM compared with age matched controls. Validation of the TYM with two standard tests (the mini-mental state examination (MMSE) and the Addenbrooke’s cognitive examination-revised (ACE-R)). Sensitivity and specificity of the TYM in the detection of Alzheimer’s disease.Results Control participants completed the TYM with an average score of 47/50. Patients with Alzheimer’s disease scored an average of 33/50. The TYM score shows excellent correlation with the two standard tests. A score of ≤42/50 had a sensitivity of 93% and specificity of 86% in the diagnosis of Alzheimer’s disease. The TYM was more sensitive in detection of Alzheimer’s disease than the mini-mental examination, detecting 93% of patients compared with 52% for the mini-mental state exxamination. The negative and positive predictive values of the TYM with the cut off of ≤42 were 99% and 42% with a prevalence of Alzheimer’s disease of 10%. Thirty one patients with non-Alzheimer dementias scored an average of 39/50.Conclusions The TYM can be completed quickly and accurately by normal controls. It is a powerful and valid screening test for the detection of Alzheimer’s disease.

The Death Knoll for the MMSE: Has It Outlived Its Purpose?

“…Indeed, patients with AD have been found to perform more poorly than other demented patients on the items ''recall of 3 words'' and ''orientation to time'' while those with vascular dementia did more poorly on items of attention. 23 However, Brown et al 22 found that the MMSE could only detect a low 52% of their patients with AD. Furthermore, frontal patients typically suffer more from problems with executive functioning (EF), an aspect of cognition that is underrepresented in the test.…”

“…Due to the fact that the MMSE is memory-and languageoriented, it has a bias toward temporal and parietal lobe functioning 22 and as such should be more sensitive in patients with degeneration and/or lesions in these areas. Indeed, patients with AD have been found to perform more poorly than other demented patients on the items ''recall of 3 words'' and ''orientation to time'' while those with vascular dementia did more poorly on items of attention.…”

The Computerized Self Test (CST): An Interactive, Internet Accessible Cognitive Screening Test For Dementia

“…The groups in this study were classified in a similar fashion with MMSE scores as a reference base. The MMSE scores for each group are: Control (28)(29)(30), MCI (26-29/MoCA < 26 and > 20), Early AD (23)(24)(25)(26), mild to moderate AD (18)(19)(20)(21)(22), moderate to severe AD (11)(12)(13)(14)(15)(16)(17)(18), and severe AD (< 10), respectively.…”

“…Differentiation of other forms of dementia with distinct neurocognitive patterns (Diffuse Lewy Body Disease, Subcortical Vascular Dementia, Frontal Lobe Dementia) from AD within patients presenting with memory complaints is of particular interest to researchers [18] as well as clinicians [19,20]. Brief screening instruments have been developed with acceptable levels of sensitivity and specificity [21][22][23][24][25][26]. However, prior studies suggest that improvements in the practical application and interpretation of these instruments will aid in their usefulness in both specialty clinics and primary care setting [7].…”

P3–222: Detection of mild cognitive impairment and early‐stage dementia with an audio‐recorded cognitive scale

“…Screening measures such as the Mini-Mental Status Examination (MMSE) are particularly insensitive to distinguishing MCI from normal controls or those with AD (Mitchell, 2009). Other tools such as the Montreal Cognitive Assessment (Nasreddine et al, 2005), Test Your Memory (TYM) (Brown et al, 2009) and telephone screening batteries (Manly et al, 2011;Hill et al, 2005) require a trained administrator or clinician and provide only a global score without information on specific profiles of deficits across different cognitive domains.…”