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The traditional scoring for the CERAD and ADAS-Cog 10-word recall tests uses a cut-off score based on the number of words recalled during the delayed recall task. However, considering the 1 trillion (2⁴⁰) patterns of recalling 10 words across four trials (3 immediate recall trials and 1 free delayed recall trial), the use of only the delayed recall total score ignores almost all of the available information.

To improve on the traditional approach, the MCI Screen draws upon the subject’s complete recall pattern across all four recall trials and uses computerized analysis to optimize the scoring method.

COMPARISON OF ACCURACY VS. OTHER ASSESSMENTS
The Mini Mental Status Exam (MMSE), perhaps the most popular and most widely used assessment, is a broad but simple measure of memory, orientation, and executive function. Despite its past popularity, it cannot reliably distinguish mild cognitive impairment (MCI) or very mild dementia from normal aging.

The MMSE is accurate in identifying impairment only when it has progressed to dementia. For a comparison of the accuracy of the MCI Screen to other assessments, click here [pdf: 51k].

THE MCI SCREEN VALIDATION
The MCI Screen was originally validated in a study on 471 community dwelling adults whose scores on the Clinical Dementia Rating Scale ranged from 0 (normal: N=119), 0.5 (mild cognitive impairment: N=95), to 1 (mild dementia: N=257). The MCI Screen showed overall accuracy of 98% with sensitivity of 97% for mild cognitive impairment or mild dementia, and 88% specificity for normal aging. The accuracy of the MCI Screen was first published in the Proceedings of the National Academy of Sciences in 2005 (read this article [pdf: 155k]).

The MCI Screen was further validated in a study on 215 patients in a primary care setting. The study found that 23% of patients had cognitive impairment due to underlying medical conditions including Alzheimer's disease (43%), cerebrovascular disease (36%), and other causes (21%). The MCI Screen enabled detection of early-stage impaired patients much more accurately than other assessments that have traditionally been used by clinicians. The MCI Screen showed overall accuracy of 96%, while MMSE and Clock Drawing Test (CDT) showed 62% and 54%, respectively. This study was published in the Journal of Alzheimer's Disease (read this article [pdf: 102k])

Additional clinical studies on the MCI Screen have been completed in Japan (Reference: Cho A. et al. Jap. J. Clin. Exp. Med. 2007; 84(8): 1152-1160). One study evaluated 63 patients at the Fukuoka University memory clinic using the Clinical Dementia Rating (CDR) Scale to identify a sample of 52 MCI (CDR= 0.5) and 11 normal aging (CDR=0) patients. These patients were given a standard diagnostic workup including the MCI Screen, the Depression Screen, brain SPECT and/or quantitative MRI. After excluding 7 patients diagnosed with depression, the neuroimaging and MCI Screen results of the remaining 56 patients were compared. Among the 48 MCI patients, 46 were correctly classified by the MCI Screen (96% sensitivity), and 37 (80%) had specific ADRD etiology diagnosed by neuroimaging. The 8 normal aging patients were correctly identified by both the MCI Screen and the neuroimaging studies. These findings support the use of the Japanese version of the MCI Screen followed by SPECT or quantitative MRI in early detection and diagnosis of MCI.