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:
