BMJ Online: Dr. Jeremy Brown's Simple New Test Screens For Early Alzheimer's and Dementia

A new test that evaluates cognitive ability -- and which you can give yourself -- appears to be faster and more accurate than current tests in detecting early dementia, according to British researchers.  

Published in the BMJ online June 10, 2009.  Dr. Jeremy Brown,  Addenbrooke's Hospital, Cambridge, England

Scroll right to the bottom of the page if you want to try out the test.

Is there anything more frightening than a diagnosis of Alzheimer's or dementia? 

Dementia is far more common than we'd like it to be. It's estimated that "24 million people in the world suffer from dementia and the number will double every 20 years."  Certainly, not all dementia is Alzheimer's disease.  Cognitive problems plague those with stroke, Parkinson's disease, head injury, and epilepsy.  And still more will suffer from milder forms of cognitive impairment.

But, as Dr. Clair Nicholl of Addenbrooke's Hospital says in an editorial accompanying Brown's BMJ article, "Without a diagnosis, patients and caregivers cannot access the services they need, so earlier diagnosis is a key component of the National Dementia Strategy in the United Kingdom.  However, early diagnosis is not easy and no definitive test exists.  A quick screening test is needed in primary care and general hospital practice."

Dr. Brown's new "Test Your Memory - The TYM Test" is quick to use, examines 10 skills, and reportedly detects 93% of the cases of Alzheimer's disease.  Brown says this self-administered test is a powerful and valid screening tool, more sensitive than the standard Mini-Mental State Examination (MMSE)  (93% vs 52%).

Remember, this is strictly a screening tool. Further professional evaluation is always necessary, and low scores may be attributed to anxiety or dyslexia.

This test has participants write 10 answers on a double-sided card, and the tasks evaluate a range of areas--the patient's semantic knowledge--the ability to calculate--name objects--recall information.  Looking at the questions it seems clear to me that the test would have to be modified (controlled) for age, ethnic, racial, & cultural biases to work in the U.S.

A sample of the questions:  List 4 creatures beginning with "S".  In what year did the 1st World War start?

It took people who had no history of cognitive problems about five minutes to complete the test. Their average score was 47. However, people with Alzheimer's took longer to finish the test and earned an average score of 33. People with mild cognitive impairment had an average score of 45.

Certainly, longer scales and more thorough testing would be required for a firm diagnosis, but this test looks like it just might be a simple accurate sensitive tool to diagnose cognitive problems.  Dr. Brown claims it is sensitive enough to distinguish between mild cognitive impairments that may likely progress to dementia within two years, from those that likely will not.

Read Dr. Jeremy Brown's BMJ article, "Self-administered cognitive screening test (TYM) for detection of Alzheimer's disease: cross sectional study" here.

Read Dr. Claire Nicholl's BMJ editorial, "Diagnosis of dementia.  The usefulness of screening tests varies according to the clinical setting" here.

And for the best or worst part--try the test yourself.  The scoring is included.  Click here.  **Remember this was developed in England--you might want to substitute the U.S. President for the Prime Minister--and consider the year the U.S. got involved in WWI--I'm by no means a test-maker--but those seem reasonable switches.

For more detailed scoring click here  I wasn't able to access this page at the time of this writing.

For a link to the Press Release about the test, click here.

And while I'm on the subject of dementia & Alzheimer's, take a look at this excellent short article from the New York Times: "Getting Insurance for One's Frailest Years", by Walecia Konrad. Nothing is more devastating to families and finances than getting good care for a family member with dementia.  After reading this, my husband & I are starting to research the options.

Comments

[Beverly Alexander]

Anyone who wants to take this test should first check out the comments section (called Rapid Response) after the BMJ article! Apparently there is a high statistical probability of false positives. A false positive would cause tremendous unnecessary suffering. Follow this link, and then either click on topics you find interesting or scroll down to the full comments:

http://www.bmj.com/cgi/eletters/338/jun08_3/b2030#215134

[The Healthy Librarian]

Thanks so much Bev for following up with the Rapid Response comments & including your "warning comment" of false positives!!!

The importance of such a test is in its use as an early screening tool---to then see a specialist for in-depth additional testing. The earlier one can make a diagnosis, the more opportunity for therapy and planning.

That's the problem with many screening tools (including mammography)--there are false positives--and this particular tool definitely is culturally biased.

Nevertheless, it's very easy for relatives to put off testing and brush off memory & cognitive lapses as "just normal aging"---a mistake. Just my opinion.