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Questionnaire May Help Spot Early Dementia
Date:6/10/2009

Experts caution that do-it-yourself test still needs doctors' interpretation,,,, ,,

WEDNESDAY, June 10 (HealthDay News) -- 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.

Called "Test Your Memory," or TYM, the test "shows great promise as a screening test for Alzheimer's or in monitoring response to treatment," said lead researcher Dr. Jeremy Brown, a consultant neurologist at Addenbrooke's Hospital in Cambridge, England. However, he said, "so far it has only been tested in one clinical scenario, and it needs assessment in others."

People can take the test, in questionnaire form, on their own, but it still must be interpreted by medical professionals.

And it's not considered a diagnostic test for Alzheimer's disease, Brown said, but he added that it could be useful in identifying people who need further evaluation.

"A good TYM score means that it is very unlikely a patient has Alzheimer's," he explained. "A poor TYM score [could have] several causes, such as anxiety or dyslexia, but the possible causes include Alzheimer's disease," he explained.

The report is published in the June 9 online edition of BMJ.

For the study, Brown and his fellow researchers gave the TYM exam to 540 people, 18 to 95 years old, who had no history of neurological disease, memory problems or brain injury. They also gave the exam to 139 people who had been diagnosed with Alzheimer's or mild cognitive impairment.

They compared the results of the TYM exam with two commonly used cognitive tests, the mini-mental state examination and the Addenbrooke's cognitive examination-revised, which the participants also were given.

For the TYM, people are asked to complete 10 tasks that test their ability to copy a sentence, to determine word meanings and to do calculations as well testing verbal fluency and recall. The ability to do the test is also scored. Each task can earn the test-taker a maximum of 50 points.

One TYM question, for instance, might be to name four animals beginning with the letter "S," Brown said.

It took people who had no history of mental 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, the researchers found.

The TYM identified 93 percent of those with Alzheimer's, whereas the mini-mental state examination identified only 52 percent of the people with Alzheimer's -- suggesting that the TYM test is more sensitive in detecting mild Alzheimer's disease. In addition, Brown said, the TYM takes less time to do than the mini-mental state examination, though it tests a wider range of cognitive areas.

The Addenbrooke's cognitive examination tests a similar number of cognitive areas and is sensitive to mild Alzheimer's, but it takes 20 minutes to take and score, he said.

Dr. Claire Nicholl, a consultant physician in medicine for the elderly at Addenbrooke's Hospital and author of an accompanying editorial in the journal, noted that cognitive tests can be helpful, but they're just part of the full work-up needed to determine the cause of someone's problem.

"If a person is developing dementia, they have difficulties in addition to poor short-term memory, for example with language and orientation," Nicholl said. "Tests such as the TYM explore these in a brief but structured way."

However, there's no one ideal test, and the best test will depend on the setting, she said. "The tests are part of the clinical evaluation," Nicholl said. "It is still necessary to take a history and examine the patient and to consider problems that may affect thinking, such as depression."

William Thies, vice president for medical and scientific affairs at the Alzheimer's Association, said he thinks the TYM exam needs to be tried in many more places with many more people before it could be widely used.

"This is really only the beginning of establishing the credibility of this test," Thies said. "You need to make sure it works in broad portions of the population."

To be widely used, the test needs to take into account the cultural and language differences of various groups, Thies said.

But if the test meets all these challenges, it could be useful in identifying people who do not need further evaluation, he said. "As a triage tool, this might be pretty good," he said.

More information

The Alzheimer's Association has more on Alzheimer's disease.



SOURCES: Jeremy Brown, M.D., consultant neurologist, Addenbrooke's Hospital, Cambridge, England; Claire Nicholl, B.Sc., F.R.C.P., consultant physician, Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, England; William Thies, Ph.D., vice president, medical and scientific relations, Alzheimer's Association, Chicago; June 9, 2009, BMJ, online


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