Page last updated at 00:22 GMT, Wednesday, 10 June 2009 01:22 UK

'Improved' test for Alzheimer's

Elderly man taking an Alzheimer's test
The test could be carried out in a waiting room

A new mental agility quiz could help detect Alzheimer's disease more accurately than the traditional test, Cambridge researchers say.

The test can be carried out by patients themselves, potentially while sitting in a GP or hospital waiting room.

Writing in the BMJ Online, researchers say it provides more accurate results than the standard mini mental-state examination, or MMSE.

This test has been used for decades to assist doctors in making a diagnosis.

One criticism has been than it is too easy, and may miss some patients in the early stage of the disease when treatment with anti-cholinesterase drugs - which reduce the breakdown of an important chemical in the brain - can be most effective.

It must also be carried out by a nurse or doctor and can take time to administer.

SAMPLE TYM QUESTIONS
Why is a carrot like a potato?
Remember this phrase: Good citizens always wear stout shoes
Draw the hands so the time reads 9:20 on this clock
In what year did the First World War start?
List four creatures beginning with the letter S
Sums: 20-4=,16+17=, 8x6=, 4+15-17=

Jeremy Brown, a consultant neurologist at Addenbrooke's Hospital said the new Test Your Memory (TYM) evaluation detected 93% of patients with Alzheimer's in a trial involving 540 healthy people and 139 patients. This compared with 52% of patients when using the MMSE.

In particular, the language and memory tests are more difficult, requiring the patient to recall a longer sentence and use language in different ways. It also includes two visuospatial tasks, which are believed to be important for differentiating Alzheimer's from other memory problems.

The perennial "who is the prime minister?" question remains however.

Researchers hope to be able to make the test available for GPs who want it to download shortly.

SAMPLE MMSE QUESTIONS
Three objects named: apple, table, penny. Patient must repeat and remember later
What are these? (a pencil and a watch)
Spell "WORLD" backwards
Patient to copy a picture of pair of intersecting pentagons
Follow a three stage command: Place index finger of right hand on your nose and then on your left ear

"Although this is a very simple test that can be done alone, it's not really to be done at home as there are all sorts of reasons why people may not perform well that are not related to Alzheimer's," said Dr Brown.

"But we are really pleased to have developed something which may improve early diagnosis as there are in many cases effective action that can be taken. In particular we think it will be much easier to use with people who do not have english as a first language."

In an accompanying editorial, Addenbrooke's consultant physician Claire Nicholl wrote: "If the Test Your Memory test is to be adopted more widely it must be validated in a range of settings and different populations.

"Until then, the most important message is that clinicians should identify a test that suits their clinical setting, use it to screen or case find as appropriate, and develop experience in its use to improve the identification of patients with early dementia."

Step forward

Rebecca Wood, chief executive of the Alzheimer's Research Trust, which funded the research, said the new test was a big step forward in efforts to spot the early signs of dementia, as two-thirds of the 700,000 people in the UK with dementia remain undiagnosed.

She said: "It works well on people of all social classes and educational backgrounds.

"'Test your memory' is easy to self-administer, involving tasks like copying a sentence, calculations, verbal fluency and recall tests.

"The test is not yet widely available, but further examination of its effectiveness in more diverse settings could lead to it being rolled-out nationwide."

Professor Clive Ballard, director of research at the Alzheimer's Society, said: "A test that helps detect dementia sooner could help more people access vital care and support earlier.

"However, much more research is needed to see if this test works in different settings with different groups of people and whether it is sufficiently sensitive to detect Alzheimer's early."



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