Development and Validation of the Memory Orientation Screening Test (MOST™): A Better Screening Test for Dementia

Abstract

Objectives: Accurate, economical identification of cognitive impairment would increase dementia detection and improve care of older patients. Design: Analysis of archival neuropsychological data combined 3-word recall, time orientation, list memory, and clock drawing into the Memory Orientation Screening Test (MOST ™). The MOST was compared with Folstein Mini Mental State Examination (MMSE) and Mini-Cog to detect dementia presence and severity, and convergence with standardized neuropsychological tests. Internal consistency, retest reliabilities, completion likelihood, and time costs were calculated. Results: The MOST was significantly more sensitive than MMSE or Mini-Cog, twice as accurate as MMSE for identifying mild dementia, better correlated with standardized memory tests, more reliable over time, and minimally related to depression. Conclusions: The MOST is routinely administered in less than 5 minutes by a medical assistant, more accurately identifies dementia and severity than current screening tests, and emulates longer memory testing, making it valuable for Annual Wellness Visits and many applied clinical settings.

Keywords

Alzheimer’s dementia screening test

References

Sousa R. , Ferri C. , Acosta D. , et al. Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey. Lancet. 2009;374(9704):1821-1830.

Alzheimer’s Disease International. World Alzheimer Report 2009. http://www.alz.co.uk/research/worldreport . Accessed February 7, 2010.

Atri A. , Shaughnessy L. , Locascio J. , Growden J. Long-term course and effectiveness of combination therapy in Alzheimer Disease . Alzheimer Dis Assoc Disord. 2008 ;22(3):209-221.

U.S. Congress. Patient protection and affordable care act. HR3590, section. 4103. http://thomas.loc.gov/cgi-bin/query/F?c111:5:./temp/~c111eV6b2b:e1461671. Accessed February 7, 2010.

Boustani M. , Peterson B. , Hanson L. , Harris R. , Lohr KN Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med . 2003;138(11):927-937.

Boise L. , Eckstrom E. , Fagnan L. , et al. The Rural Older Adult Memory (ROAM) Study: a practice-based intervention to improve dementia screening and diagnosis. J Am Board Fam Med. 2010;(23):486-498.

Chodosh J. , Petitti DB , Elliot M. , et al. Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc. 2004 ;52(7):1051-1059.

Okonkwo O. , Spitznagel M. , Alosco M. , Tremont G. Associations among measures of awareness of cognitive deficits in dementia . Alzheimers and Dement. 2010;6(4):312-318.

Scapagnini G. , Caruso C. , Vasto S. , et al. Genetic risk factors and candidate biomarkers for Alzheimer’s disease. Front Biosci. 2010;2:616-622.

10.

Solomon P. , Hirschoff , Kelly B , et al. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer’s Disease. Arch Neurol. 1998;55(3):349-355.

11.

Borson S. , Scanlon J. , Brush M. , Vitaliano P. , Dokmak A. The Mini-Cog: a cognitive vital signs measure for dementia screening . Int J Geriatr Psychiatry. 2000;15(11):1021-1027.

12.

Malani PN Functional status assessment in the preoperative evaluation of older adults . JAMA. 2009 ; 302(14):1582-3.

13.

Pisani MA , Murphy TE , Van Ness PH , Araujo KL , Inouye SK Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med. 2007 ;167(15): 1629-1634.

14.

Bellelli G. , Frisoni GB , Turco R. , Lucchi E. , Magnifico F. , Trabucchi M. Delirium superimposed on dementia predicts 12-month survival in elderly patients discharged from a postacute rehabilitation facility. J Gerontol A Biol Sci Med Sci. 2007 ;62(11):1306-1309.

15.

Bentler SE , Liu L. , Obrizan M. , et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009;170(10):1290-1299.

16.

Mitchell SL , Teno JM , Kiely DK , et al. The clinical course of advanced dementia . N Engl J Med. 2009;361(16):1529-1538.

17.

Folstein MF , Folstein SE , McHugh PR ‘ Mini-Mental State ’: a practical method for grading cognitive states of patients for the clinician . J Psychiatr Res. 1975;12(3):189-198.

18.

Nasreddine ZS , Phillips NA , Bédirian V. , et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment . J Am Geriatr Soc. 2005;53(4):695-699.

19.

Wechsler D. Wechsler Adult Intelligence Scale-Revised . New York, NY : Psychological Corp; 1988.

20.

Kaplan EF , Goodglass H. , Weintraub S. The Boston Naming Test. Boston, MA: E Kaplan & H Goodglass; 1978.

21.

Benton AL , Hamsher KdeS. Multilingual Aphasia Examination. Iowa City, IA : University of Iowa; 1978.

22.

Wechsler D. Wechsler Memory Scale-Revised. New York, NY: Psychological Corporation; 1987.

23.

Gollin ES Developmental studies of visual recognition of incomplete objects . Percept Motor Skills. 1960;11:289-298.

24.

Reitan RM The relation of the trail making test to organic brain damage. J Consult Psychol. 1955;19(5):393-394.

25.

Sanford J. , Turner A. Integrated Visual and Auditory Continuous Performance Test Manual . Richmond, VA: BrainTrain; 2002.

26.

Sherman LM , Merrill MA Stanford-Binet Intelligence Scale. Manual for the Third Revision. Form L-M . Boston, MA: Houghton Mifflin; 1973.

27.

Sheikh JI , Yesavage JA Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5(1-2):165-173.

28.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

29.

Morris JC The Clinical Dementia Rating Scale (CDR): current version and scoring rules . Neurology. 1993;43(11):2412-2414.

30.

Petersen RC , Negash S. Mild cognitive impairment: an overview. CNS Spectr. 2008;13(1):45-53.

31.

McKhann G. , Drachman D. , Folstein M. , Katzman R. , Price D. , Stadian EM Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34(7):939-944.

32.

Chui HC , Mack W. , Jackson JE , et al. Clinical criteria for the diagnosis of vascular dementia: a multi-center study of comparability and interrater reliability. Arch Neurol. 2000;57(2):191-196.

33.

Pijnenburg Yal , Mulder JL , van Swieten JC , et al. Diagnostic accuracy of consensus diagnostic criteria for frontotemporal dementia in a memory clinic population. Dement Geriatr Cogn Disord. 2008;25(2):157-164.

34.

Loretz W. , Scanlan J. , Borson S. Brief screening tests for dementia. Can J Psychiatry . 2002;47(8):723-733.

35.

Borson S. , Scanlan JM , Watanabe J. , Tu S. , Lessig M. Improving identification of cognitive impairment in primary care. Int J Geriatr Psychiatry. 2006;21(4):349-355.

36.

Pezzotti P. , Scalmana S. , Mastromattei A. , Di Lallo D. , Progetto. Alzheimer Working Group. The accuracy of the MMSE in detecting cognitive impairment when administered by general practitioners: a prospective observational study. BMC Fam Pract. 2008;9:29.

37.

Loretz L. Primary Care Tools for Clinicians: A Compendium of Forms, Questionnaires, and Rating Scales for Everyday Practice. St Louis, MO: Elsevier Mosby; 2005.

38.

NIH Clinical Trials Registry http://clinicaltrials.gov.IdentifierNCT01057602. Accessed February 7, 2010.

39.

Gleason CE , Gangnon RE , Fischer BL , Mahoney JE Increased risk for falling associated with subtle cognitive impairment . Dement Geriatr Cogn Disord. 2009;27(6):557-563.

40.

Allan LM , Ballard CG , Rowan EN , Kenny RA Incidence and prediction of falls in dementia. PLoS One. 2009;4(5):e5521.

41.

U.S. Congress. Patient protection and affordable care act. HR3590, section. 4103. http://thomas.loc.gov/cgi-bin/query/F?c111:5:./temp/~c111eV6b2b:e1461671. Accessed February 7, 2010.