Tuesday, April 27, 2010

Self-Administered Screening Tool for Alzheimer’s

Alzheimer's Disease (AD) is a disease that affects many people over the age of 50. Characterized by memory loss, loss in reasoning and decision-making ability; it affects not only the victim, but also friends and relatives.
The TYM (Test Your Memory)test is a new cognitive test comprising of 10 tasks presented on 2 sides of a single sheet of soft card. Most people take about 5 minutes to complete the TYM. The test can be completed under supervision from a health professional. The maximum score is 50/50.

This test is very easy to do but it is worthwhile noting that this test is not a concrete Alzheimer’s test. You will still have to seek medical advice for an accurate diagnosis. However, this self-administered test could represent a very efficient way for early diagnosis of Alzheimer’s disease. The 10-task test appears to be even more sensitive in picking out the early disease symptoms, comparing with standard Alzheimer’s test, according to results of the new scientific research.

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Early diagnosis of Alzheimer’s disease is important and the mini-mental state examination (MMSE) is the standard way of detecting the condition. But a new study from Cambridge, UK, suggests that there might be a better way, with a simpler test. The study compares the self-administered cognitive screening test (TYM, or ‘test your memory’) with the MMSE and finds it performs better.

The main symptom of Alzheimer’s disease is decline in memory, although other cognitive deficits are also important. Although there is no cure for Alzheimer’s disease, as yet, there are treatments and interventions that may delay the progress of the condition. That is why earlier and more accurate diagnosis is so important.

What was done?
Researchers at Addenbrooke’s Hospital, Cambridge, UK, devised and evaluated a new test called TYM (Test Your Memory). It is a series of ten tasks including the ability to copy a sentence, knowledge of words and their meaning, calculation, verbal fluency and recall ability. The ability to carry out the test is also noted. Each of the tasks has a score and the total for the TYM test is 50 points. The researchers had a group of 540 healthy individuals aged 18 to 95 years carry out the test. They also tested 139 patients with either Alzheimer’s disease or mild cognitive impairment. The test was compared to the MMSE and another standard test called the Addenbrooke’s cognitive examination.

What was found?
The healthy controls completed the test in an average time of five minutes. Their average score was 47 out of 50. Those with Alzheimer’s had a lower average score of 33. Those with mild cognitive impairment scored an average of 45. Average performance was constant between ages 18 and 70, with a small decline after this age. Scores did not vary between men and women or with geographical location, suggesting the socioeconomic factors might have only minor impact on the results. The TYM could detect 93% of those with Alzheimer’s disease while the MMSE detects only 52% of those with the condition.

What this study means?
The TYM is faster to administer than MMSE and does not need highly qualified people to do so. It is also more accurate and tests a wider range of cognitive abilities. The Addenbrooke’s test is also more sensitive than MMSE, but takes longer to administer. Therefore, the TYM looks very promising, but it now needs to be validated in a wider range of clinical settings.

The TYM Features
The average TYM score for normal individuals is 47/50 up until the age of 70 years and then there is a small decline.
The TYM test has several features which should help the diagnosis and management of patients with memory problems:
  1. The patient fills in the test themselves. This saves time.
  2. The TYM test is a permanent self-written record of a patient’s achievement on a certain date and can be referred back to.
  3. The TYM tests 10 different cognitive domains including anterograde memory, semantic knowledge and visuospatial skills which are typically affected early in Alzheimer’s disease.
  4. There is a very clear distinction between the scores of normal controls (average 47/50) and patients with mild AD (average 33/50). A cut off of 42 has a sensitivity of 93% and specificity of 86% in the diagnosis of AD in our study.
  5. It is powerful in detecting mild Alzheimer's disease detecting 93% of cases in our study.
The TYM Details
You can pass the Alzheimer’s Test by downloading the following files from the BMJ:

Please note that it’s not a clinical diagnosis of Alzheimer's disease. It is only a screening tool for patients who may have Alzheimer’s disease. There are many reasons why patient will score poorly on the TYM for example poor concentration. A poor TYM score does not mean a patient has Alzheimer’s but a reason for the poor score needs to be sought. If you are concerned about your memory, it is recommended seeking medical advice. Note that the test can be applied only for English speaking individuals. It has been already translated on about 20 languages, and it is in the process of validation internationally. Non-English versions of TYM will be posted as soon as validation is completed.

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Also, the text for the test was created in England and should be adapted to the area where you live, such as take out "Who is the Prime Minister" and put, for example, in "Who is the President of the United States. Also something more common, like "Most people wear jeans for casual wear" instead of "Good citizens always wear stout shoes".

Sources and Additional Information:
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