CHICAGO – A quick, computerized screening test for dementia may be one step closer to reality.
Researchers at the University of Florida Alzheimer's Center and Research Institute have developed the Dementia Screening Battery, a self-administered test that takes about 15 minutes to complete on a laptop computer.
In contrast, the currently widely used Mini-Mental State Examination (MMSE) is administered by a trained professional and can take up to 90 minutes to complete.
The computerized screener can be used with even severely demented populations, and all tests in the battery were based on tests in the public domain to minimize costs, principal investigator Dr. Kenneth M. Heilman and colleagues reported in a poster at the annual meeting of the American Academy of Neurology.
“The availability of a self-administered computerized cognitive screening test could improve public-health awareness of dementia and lead to earlier treatment, as well as reduce the burdens of time and staff training for primary care providers,” Dr. Heilman, distinguished professor and program director department of neurology, University of Florida, Gainesville, said in an interview.
The investigators tested the Dementia Screening Battery in 39 healthy adults (mean age 64 years) and 66 adults (mean age 72 years) who were diagnosed by a behavioral neurologist as having abnormal cognition, including mild cognitive impairment in 19, probable Alzheimer's disease in 17, and other dementias in 30.
All participants were given the MMSE, and assessed for ideomotor apraxia and executive dysfunction. The traditional Hopkins Verbal Learning Test and Boston Naming Test were given to 90% of patients and 62% of controls.
There were no significant differences between the screening battery and MMSE performance, although there was a trend for superior performance of the MMSE in identifying patients in the “other dementias” group, the investigators reported.
A laptop total score of 75 proved to be the optimal cutoff point, providing the maximal specificity (72%) and sensitivity (92%).
The area under the receiver operating characteristics (ROC) curve was high at 0.94 and comparable with the MMSE at 0.95.
Subtests of memory, naming, praxis, and orientation from the Dementia Screening Battery significantly correlated with standard domain-related neuropsychological tests. The Pearson Correlation between the laptop total score and the MMSE was significant at 0.80.
The investigators acknowledged the generally high level of education (mean 15 years) and computer literacy in the patients, who were selected from an academic referral practice. There also may have been a selection bias because of the consenting process, as patients who are intimidated by computers or whose dementia severity precluded their likelihood of successfully completing the test may have refused to participate.
Future steps include implementation of reaction times, the addition of more sensitive tests for frontal-executive dysfunction, simplification of the keyboard, and testing the device on a communitywide level.
All tests in the computerized battery were based on tests in the public domain to minimize costs. DR. HEILMAN