New rapid cognitive screening test could help diagnose early
10 June 2009
A new cognitive test for detecting Alzheimer's disease is quicker and
more accurate than many current tests, and could help diagnose early
dementia, according to researchers at Addenbrooke's Hospital in
An estimated 24 million people throughout the world have dementia and
the number affected will double every 20 years. Early diagnosis is
crucial to effective treatment, but there is no available short
cognitive test that is quick to use, examines various skills, and is
sensitive to Alzheimer's disease.
So researchers at Addenbrooke's Hospital in Cambridge designed and
evaluated a new cognitive test, the TYM (test your memory), in the
detection of Alzheimer's disease. The results have been published in the
British Medical Journal on bmj.com.
The TYM is a series of 10 tasks including ability to copy a sentence,
semantic knowledge, calculation, verbal fluency and recall ability. The
ability to do the test is also scored. Each task carries a score with a
maximum score of 50 points available. The test is designed to use
minimal operator time and to be suitable for non-specialist use.
The test was completed by 540 healthy individuals (controls) aged 18
to 95 years of age with no history of neurological disease, memory
problems or brain injury. A further 139 patients with diagnosed
Alzheimer's or mild cognitive impairment were also tested.
The test was compared with two commonly used bedside cognitive tests
— the mini-mental state examination and the Addenbrooke's cognitive
The mini-mental state examination has been the standard short
cognitive test for 30 years and is the main test chosen by the National
Institute for Health and Clinical Excellence (NICE) for deciding which
patients should receive drugs and for monitoring their response to
Controls completed the test in an average time of five minutes and
gained an average score of 47 out of 50. Patients with Alzheimer's
disease performed much poorer than controls with an average score of 33
out of 50. Patients with mild cognitive impairment scored an average of
45 out of 50.
The average TYM score remained constant between the ages of 18 and 70
years, with a small decline in performance after this age. Scores did
not differ between men and women or by geographical background,
suggesting that education and social class would have only mild effects
on the TYM score.
The TYM detected 93% of patients with Alzheimer's disease, while the
mini-mental state examination detected only 52% of patients, suggesting
that the TYM test is a much more sensitive tool for detecting mild
Alzheimer's disease. Compared to the mini-mental state examination, the
TYM also takes less time to administer and tests a wider range of
The Addenbrooke's cognitive examination tests a similar number of
cognitive domains to the TYM and is sensitive to mild Alzheimer's
disease, but it takes 20 minutes to administer and score.
The TYM is a powerful and valid screening test for the detection of
Alzheimer's disease, conclude the authors.
The usefulness of screening tests varies according to the clinical
setting, says consultant physician Claire Nicholl in an accompanying
If the test your memory test is to be adopted more widely it must be
validated in a range of settings and different populations, she writes.
Until then, the most important message is that clinicians should
identify a test that suits their clinical setting, and develop
experience in its use to improve the identification of patients with
Professor Clive Ballard, Director of Research, Alzheimer's Society
commented: "A test that helps detect dementia sooner in local health
care facilities could help more people access vital care and support
earlier. However, more research is needed to see if this test works in
different settings with different groups of people and establish whether
it is more effective than the most sensitive existing tests.
One million people will develop dementia in the next 10 years and
currently only a third of people with the condition ever receive a
diagnosis. We must start investing in research if we are to radically
improve the current picture and defeat this devastating condition."
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