SS3.03: Cognitive screening for dementia: crossing four essential borders

Update on the Montreal Cognitive Assessment (MoCA) (J.F.M. de Jonghe): This presentation aims to provide an overview of item content of the Montreal Cognitive Assessment (MoCA) and an update of studies using the MoCA in different patient populations. The MoCA assesses several cognitive domains including episodic memory (by two learning trials of five nouns and a delayed recall task), constructional praxis (by a clock-drawing task and a three-dimensional cube copy), executive function (by a short form of the Trail-making task part B), a phonemic fluency task, a verbal abstraction task, attention and working memory (by a sustained attention task, a serial subtraction task, and digits forward and backward), language (by a confrontation naming task, repetition of two sentences, and a fluency task). Finally, orientation to time and place is also evaluated. The MoCA measures these different cognitive domains with less ceiling effects in patients who have mild degrees of cognitive impairment. Thereby, the MoCA is a promising tool for detecting Mild Cognitive Impairment (MCI) and Early Alzheimer's disease compared to the MMSE. The MoCA has been used to assess patients with Parkinson's disease, vascular cognitive impairment, Huntington's disease, metastatic disease in the brain, primary brain tumors, multiple sclerosis, and other conditions including traumatic brain injury, depression, schizophrenia and heart failure. We conclude that the MoCA is a very useful new cognitive screening that has been validated in different patient populations. Seven Minute Screen (7MS) in a secondary care setting (B. Appels): Earlier studies showed that despite its limitations, the MMSE was by far the most commonly used instrument. In the last decades, many new dementia screening instruments have been developed in order to meet the shortcomings of the MMSE. The Seven Minute Screen (7MS) is one of these instruments. The 7MS is a dementia screening test that was originally developed to distinguish patients with probable AD from healthy controls. It consists of four brief neuropsychological tests that measure orientation in time, memory, visuospatial and executive functions. The test is available in several languages and validated in a primary care as well as in secondary care settings. In this presentation, the findings of the normative and validation study in the Netherlands in a secondary care setting (memory clinics) will be demonstrated. The results outline the sensitivity of the 7MS in mild forms of Alzheimer disease but also other forms of dementia such as vascular dementia, frontotemporal dementia and dementia with Lewy bodies. The comparison with the MMSE is made to show the superiority of the 7MS in the sense that it combines the brief administration time of the MMSE with a higher diagnostic accuracy in detecting dementia. The Cross Cultural Dementia Screening Test (CCD) in comparison to MMSE in an elderly migrant population at the memory clinic (M. Goudsmit): With the aging population in the Netherlands and other European countries, elderly migrants will form a substantial part of the elderly population in the next decade. In the Netherlands, these migrants came mostly from Turkey, Morocco and Surinam. Cognitive decline and dementia are difficult to assess with standard cognitive screening instruments in elderly migrants primarily because of language barriers but also because many migrants have low levels of education and different cultural backgrounds. At the same time, prevalence of dementia is expected to be higher due to different contributing factors such as vascular risk factors. In general, commonly used cognitive screening instruments such as the MMSE have limited applicability for non-Western elderly migrants because of the high rate of false-positive results. We developed a new non-verbal dementia screening test, suitable for the low-educated migrant population. This Cross Cultural Dementia Screening Test (CCD) exists of three subtests, which evaluate memory, executive function and psychomotor speed. Although the test materials are non-verbal, instructions are given by means of computerized voice samples in a patient's native language. Test taking is possible without an interpreter. The newly developed CCD correctly classified 89% of cases in a sample of 108 low educated elderly migrants, of which half were demented and the other half were healthy controls. Compared to other screening instruments, such as the MMSE, the CCD seems to be more accurate in this migrant population. We will present data about this comparison in the lecture. Tailoring the cognitive test to the individual patient using adaptive cognitive testing (H. Wouters): This presentation aims to give an overview of our findings about Computerized Adaptive Testing (CAT) from the past five years. CAT is a potential solution to the well-known problem that longer cognitive tests, such as the Cambridge Cognitive Examination (CAMCOG), are more precise but also less efficient than briefer tests, such as the MMSE. CAT resolves this problem by tailoring the cognitive test to the individual patient. It selects for each individual patient only items of appropriate difficulty from a large pool of items with known difficulty estimates. Two retrospective analyses of data from normal ageing participants and patients with AD (N = 797) and CVD (N = 284) showed that substantial test reductions were achieved (∼40-60%) with a CAT version of the CAMCOG (CAT-CAMCOG). At the same time, agreement between the CATCAMCOG and a whole validated item pool of CAMCOG items was high to excellent (intraclass correlations >0.95). A prospective study (N = 84) corroborated these findings. A recent retrospective analysis of data from patients with AD and LBD (N = 643) was conducted to examine whether the CAT-CAMCOG could be as useful as the whole CAMCOG for the evaluation of treatment effects of cholinesterase inhibitors. The main finding was that slightly more people had significant decline on the CAMCOG (11%) than the CAT-CAMCOG (6%). Taken together, CAT saves time and obtains very similar test results. CAT therefore deserves a role for the screening of dementia and the grading of its severity.