ATLANTA, Nov. 19 -- Mild cognitive impairment can be determined in less than five minutes with a three-word memory test and a clock-drawing task, according to researchers here. The words are apple, penny, and table.
The new screening tool, called the Mini-Cog, coupled with a Functional Activities Questionnaire, allowed researchers to classify patients with 83% accuracy as cognitively normal, demented, or mildly cognitively impaired, James Lah, M.D., of Emory, and colleagues reported online in the Journal of Alzheimer's Disease.
Action Points
- Explain to interested patients that a brief test paired with a functional activities questionnaire accurately diagnosed 83% of patients with mild cognitive impairment.
- Note that current screening for mild cognitive impairment typically requires 40 to 60 minutes of formal neuropsychological testing to achieve 80% accuracy or higher.
"A test like this is key to helping individuals detect this devastating disease earlier and maintain a good quality of life for as long as possible," Dr. Lah said.
Current screening for mild cognitive impairment typically requires 40 to 60 minutes of formal neuropsychological testing to achieve 80% accuracy or higher, the researchers said.
To assess the accuracy of the overall test, the researchers did a cross-sectional study of 178 elderly patients.
About 22% were African-American, 72% were female, and 37% had a high-school education.
The Mini-Cog consisted of a clock drawing task and three-item recall that takes three to five minutes to administer. A tester recited three words -- apple, penny, and table -- and had the patient recall them later.
Patients were also given a paper with a pre-drawn circle and asked to draw a clock and set the time to ten minutes after eleven.
The questionnaire contained 30 items that were completed by an informant, such as a spouse, who rated performance on daily activities as "normal," "has difficulty but does by self," "requires assistance," or "dependent."
In addition to the overall test, the researchers administered a traditional cognitive test battery, including the Mini-Mental State Examination (MMSE) -- which takes about 10 minutes to administer -- and cognitive tests in memory, language, attention, executive function, and visuospatial ability.
Two neurologists and a neuropsychologist determined a consensus diagnosis of normal cognition, mild cognitive impairment, or dementia on the basis of these tests. About 30% of participants had mild cognitive impairment, 32% were mildly demented, and 38% had normal cognition.
The test predicted the consensus diagnosis with an accuracy of 83% and a weighted kappa of 0.81.
The specific accuracy for classifying patients with mild cognitive impairment was 74%, the researchers said.
"While this may not seem overly impressive, it is quite remarkable for a three-minute investment," Dr. Lah said.
There was agreement between the two types of classification when compared with the MMSE and the questionnaire's. Its accuracy was 85% and the weighted kappa was 0.83, and it correctly diagnosed mild cognitive impairment 68% of the time, compared with the word test and questionnaire's 74%.
While the researchers said their results need to be replicated in further studies, the findings "suggest that the administration of the MC-FAQ may be an effective and efficient approach to widespread screening for cognitive impairment."
| The authors reported no disclosures. |
Primary Source
Journal of Alzheimer's Disease
Source Reference: Steenland NK, et al "Development of a rapid screening instrument for mild cognitive impairment and undiagnosed dementia" J Alzheimers Dis 2008; 419-427.