Wednesday, March 4, 2015

MIS - Memory Impairment Screen Test for Alzheimers

Memory impairment usually is the earliest sign of Alzheimer’s disease (AD) and therefore is required and sufficient for diagnosis, according to Herman Buschke, MD, Professor of Neuroscience, Lena and Joseph Gluck Distinguished Scholar in Neurology at the Albert Einstein College of Medicine, New York City. Dr. Buschke described the Memory Impairment Screen (MIS), which consists of controlled learning, a short delay, and free recall, followed by cued recall for items that were not previously recalled. The MIS is recommended by the American Academy of Neurology as a screen for AD.

Subjects are given the names of items in four different categories (animal, city, vegetable, and musical instrument). After a short delay, the subjects are asked to name the item in each category. Such controlled learning assures attention and equal processing of all items, induces deep semantic processing, and provides sufficient time to process each item.

The MIS also demonstrates that individuals can identify the items by their cues and requires all subjects to do the same processing. This ensures that decreased recall is due to impaired memory, not impaired attention or different processing strategies. The MIS induces encoding specificity to improve retrieval by using the same cues for learning and retrieval. This enhances the detection of dementia.


Overview

Four items from different categories are learned by identifying each item when its category cue is presented. Memory is tested by free recall after a delay with interference. If any items are not retrieved by free recall, the category cues for those items are provided to elicit cued recall of those items.

1. Controlled Learning

Tell the participant, “I am going to say 4 words for you to learn and remember. Each word belongs to a different category. Please repeat all 4 words that I say out loud after I finish saying them.” Read the following words. If the participant has difficulty immediately repeating the words, you can repeat all 4 up to 3 times. (Check “Correct” if the word is correctly repeated on the first or second effort.)

"HISTORY"
"FACTORY"
"POLICEMAN"
"TOOTHBRUSH"

Then say, “To help you learn these words, I will tell you the category cue for each word and ask you to tell me the word that goes with each category cue. When I read each category cue to you, tell me which one of these words goes with that category cue.” Read each category cue aloud to the participant. If the participant does not know the word, say "The word is ...", and have the participant say the word. Then go to the next category cue. If the participant missed any of the words, the sequence of presenting categories should be repeated twice. Pace acquisition at a rate that is comfortable for the participant. (Check “Correct” when the participant states the correct word)

"BUILDING" - FACTORY
"PERSONAL ITEM" - TOOTHBRUSH
"SCHOOL SUBJECT" - HISTORY
"CITY EMPLOYEE" – POLICEMAN

When all four words have been identified to the best of the participant's ability, tell the participant,
“Later, I will ask you to recall the words.”
2. Animal Naming

First 30 seconds

Say: “In 30 seconds, tell me as many animals as you can think of. Ready, GO"

List animals named:

Total number of animals named in first 30 seconds: ____________

Second 30 seconds

If the participant named at least 4 animals in the first 30 seconds, say: “In the next 30 seconds, tell me as many more and different animals as you can think of. Ready, GO" OR If the participant named less than 4 animals in the first 30 seconds, say: “In the next 30 seconds, tell me more animals. Think of the zoo, the farm, and the jungle. Ready, GO"

List animals named:

Total number of animals named in second 30 seconds: ____________
3. Free Recall

Elicit Free Recall by asking the participant to: “Tell me as many of the 4 words you can remember, in any order.”

Allow 20 seconds for Free Recall of all four words. Stop if no more words have been recalled for 10
seconds. Note “Correct” if the word is correctly retrieved in Free Recall.

"HISTORY"
"FACTORY"
"POLICEMAN"
"TOOTHBRUSH"

Total number of “Correct” Free Recall words: ___________

4. Cued Recall

Immediately after concluding Free Recall, elicit Cued Recall of any words that were not retrieved by Free
Recall. For each word that was not retrieved by Free Recall, read the appropriate category cue to the participant in the order shown below, and ask the participant to recall the word that was learned with that cue. For example: “What was the BUILDING?” Allow 5 seconds for recall of each word cued. Note
“Correct” if the word is correctly retrieved in Cued Recall.

"BUILDING" - FACTORY
"PERSONAL ITEM" - TOOTHBRUSH
"SCHOOL SUBJECT" - HISTORY
"CITY EMPLOYEE" – POLICEMAN

Total number of “Correct” Cued Recall words: ___________

Scoring

Multiply the number of Free Recall words by 2 and add the result to the number of Cued Recall words [(2 X Free Recall) + Cued Recall] to obtain the MIS score.
Interpretation

The maximum score for the MIS is 8.
* 5-8 No cognitive impairment
* ≤ 4 Possible cognitive impairment
Lower the score – more severe cognitive impairment is expected.
A normal individual should be able to name 8 animals in 30 seconds and 15 animals in 1 minute.




Sources and Additional Information:
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