10-minute delayed recall from the modified mini-mental state test predicts Alzheimer's disease pathology.

We compared the sensitivity and specificity of two delayed recall scores from the Modified Mini-Mental State (3MS) test with consensus clinical diagnosis to differentiate cognitive impairment due to Alzheimer's disease (AD) versus non-AD pathologies. At a memory disorders clinic, 117 cognitively impaired patients were administered a baseline 3MS test and received a contemporaneous consensus clinical diagnosis. Their brains were examined after death about 5 years later. Using logistic regression with forward selection to predict pathologically defined AD versus non-AD, 10-min delayed recall entered first (p = 0.001), followed by clinical diagnosis (p = 0.02); 1-min delayed recall did not enter. 10-min delayed recall scores ≤4 (score range = 0-9) were 87% sensitive and 47% specific in predicting AD pathology; consensus clinical diagnosis was 82% sensitive and 45% specific. For the 57 patients whose initial Mini-Mental State Examination scores were ≥19 (the median), 3MS 10-min delayed recall scores ≤4 showed some loss of sensitivity (80%) but a substantial gain in specificity (77%). In conclusion, 10-min delayed recall score on the brief 3MS test distinguished between AD versus non-AD pathology about 5 years before death at least as well as consensus clinical diagnosis that requires much more comprehensive information and complex deliberation.

Chinese-language montreal cognitive assessment for cantonese or mandarin speakers: age, education, and gender effects.

The Montreal Cognitive Assessment Chinese-Language Los Angeles version (MoCA-ChLA) was developed and administered during an in-home interview to 1,192 participants (mean age 62.5 years, mean education 11.6 years) in a population-based Chinese American Eye Study (CHES) in Los Angeles. The MoCA-ChLA score (mean ± SD) was 23.8 ± 4.2 with little ceiling and no floor effects. The score increased with higher education, decreased with advancing age, and was not related to gender. Compared to the education 1-6 years group, the mean MoCA-ChLA score was 2.6 and 4.6 higher in the education 7-11 and 12-20 years groups, respectively. The Mandarin- (n = 612) and Cantonese- (n = 612) speaking subgroups performed comparably; Cronbach's alpha of the MoCA-ChLA score was 0.78 and 0.79 for these two groups, respectively. Item response theory analysis showed good discriminating power for executive function and memory. These properties support the MoCA-ChLA as a useful screening tool for aging and dementia studies for Mandarin or Cantonese speakers.

[Cognitive Abilities Screening Instrument, Chinese Version 2.0 (CASI C-2.0): administration and clinical application].

Abstract- The Cognitive Abilities Screening Instrument (CASI) has been commonly used in dementia research and clinical practice to evaluate a subject's cognitive abilities and to follow-up possible progression of dementia. It has a detailed manual for test administration and scoring in order to minimize testing errors. The Chinese version of CASI (CASI C-2.0) has been used in many clinical and epidemiological studies in Taiwan. Since cognitive abilities are influenced by education, and there are high rates of illiterate or low education individuals among the elderly in Taiwan, the normative data of CASI, including its total score and its cognitive domain scores, should be divided into different education ranges. In clinical practice, the cut-off scores in differentiating between dementia and normal are suggested to be: 49/50 for Education year = 0; 67/68 for Education years = 1-5; and 79/80 for Education years more than 6.

The common objects memory test (COMT): a simple test with cross-cultural applicability.

The Common Objects Memory Test (COMT) was developed to assess age-related memory impairments in individuals with a range of educational, language and cultural backgrounds. The COMT is a list-learning protocol that uses photographs of common objects to bypass difficulties posed by written words for individuals who are illiterate or have limited education. Preliminary data are presented for 336 healthy adults and 90 patients with dementia. Their age ranged from 54 to 99 years, education ranged from 0 to 22 years, and they were from five culturally and linguistically distinct populations: Caucasian and African-American English speakers, and native Chinese, Spanish, and Vietnamese speakers. Performance on the COMT was influenced by age, but little influenced by education, and un-influenced by gender or ethnic background. Among 11 neuropsychological tests, the recall scores from the COMT best distinguished healthy individuals from patients with dementia, underscoring its clinical utility for ethnically diverse populations.

Performance of Spanish speakers on the Mattis dementia rating scale (MDRS).

This paper examined whether education-, age-, and gender-matched Spanish- and English-speaking normals (n=30 pairs) had comparable scores on the Mattis dementia rating scale (MDRS). It provides preliminary normative data on Spanish-speaking volunteers aged 55-89 years old (n=54). It also compared the MDRS total score with its memory subscale score and the mini-mental state examination (MMSE) score on sensitivity and specificity for distinguishing normals from patients with dementia (n=61). Spanish-speaking normals scored significantly lower than English-speaking normals on MDRS total and its attention, conceptualization, and memory subscales. The area under the receiver operating characteristic curve distinguishing normals from patients with dementia was not significantly different among the MDRS total, its memory subscale, and the MMSE. We conclude that (a) the norms based on English-speaking individuals are not appropriate for use with Spanish-speaking individuals, and (b) to screen for dementia, the shorter MDRS Memory subscale and the MMSE are as good as the entire MDRS.

Neuropsychological testing: helpful or harmful?

Neuropsychological testing is important for the diagnosis and follow-up of dementia; it can also help provide consultation on patient care. However, lengthy testing is costly and can be stressful to the subjects. Tests developed for members of the majority culture often are inappropriate for ethnic minorities, especially those who speak a different language, have little or no formal education, and grew up in vastly different circumstances. Variables that directly affect test performance, such as education and acculturation instead of race or ethnicity, should be considered as explanatory variables for test performance. Reading level may be a better index for educational attainment than the number of years in school. Neuropsychological testing can be improved in several directions: (1) Use tests that are appropriate for the subject's background. (2) Use detailed scoring of a smaller number of test items to reduce test time, and establish discontinuation rules to limit the subject's experience of failure. (3) Develop parallel test forms for repeated assessment of the same individuals. (4) Strive for large and representative standardization samples. (5) Use computerized test norms based on findings of statistical analysis to better adjust for confounding variables.