Brown, J. et al. Self administered cognitive screening test (TYM) for detection of Alzheimer's disease: cross-sectional study. BMJ 338, b2030 (2009).

...doctors in busy surgeries and clinics have little time to test the cognitive function of patients

A cross-sectional study has confirmed 'test your memory' (TYM) as a powerful and valid test that can be used to detect Alzheimer disease (AD), even in its earlier stages, with a high degree of sensitivity and specificity. “The TYM should allow many patients in common clinical scenarios to be quickly and efficiently screened for AD, and possibly other dementias,” notes lead author Jeremy Brown, of the Department of Neurology, Addenbrooke's Hospital, Cambridge, UK.

Currently, many doctors in busy surgeries and clinics have little time to test the cognitive function of patients. “The current gold standard test, the Mini-Mental State Examination (MMSE), has lasted for 30 years and in some ways is fine. However, it takes 8 minutes to administer, tests only a few cognitive areas and is relatively insensitive to mild AD,” explains Brown. He had observed that most patients were waiting for around 30 minutes to start their appointment, so decided to devise a test that could be completed during this waiting period. The TYM was designed to be completed by the patient under minimal supervision from a receptionist or relative, and was set up to test 10 cognitive skills in just a few minutes.

In this study, 540 controls aged between 18 and 95 were asked to complete the TYM, and their results were compared with those from 139 patients attending a memory clinic who had been diagnosed with dementia or mild memory impairment. Controls attained an average score of 47/50, whereas patients with AD had an average score of 33/50. The TYM correlated well with two standard tests already in use and had a sensitivity of 93% and a specificity of 86% for AD diagnosis.

“The TYM has many advantages over the MMSE—it is quicker for doctors, it can be scored very accurately by a non-specialist in just 2 minutes, and it is highly sensitive for AD. The TYM picks up 93% of patients compared to only 52% identified by the MMSE,” explains Brown, who believes TYM or a similar test will become a crucial way of identifying patients when a more effective treatment for AD is found. Work is now underway to work up versions of the TYM in different languages and for different cultures, with alternative tests for patients with visual impairments. It could also be possible to devise TYM variants to test for non-AD dementias.