Which Screening Tool Is Best When You Suspect Alzheimer Disease?

November 10, 2009

Of the screening tools available to help identify early symptoms of Alzheimer’s disease, which is best?

Of the screening tools available to help identify early symptoms of Alzheimer’s disease (AD), which is best?1

In a presentation at the U.S. Psychiatric and Mental Health Congress in Las Vegas, Kevin Gray, MD, director of the Geriatric Neuropsychiatry Clinic, Veterans Affairs North Texas Health Care System, Dallas, gave a withering critique of the widely used Mini Mental State Examination (MMSE) and instead recommended simple and quickly administered tests that he says are more sensitive and specific.

“The MMSE must die” commented Gray, who said the “antique” screen is of limited diagnostic utility in most clinical settings. It takes at least 10 minutes to administer and scoring is strongly influenced by the patient’s age and education level. Moreover, it is insensitive for mild cognitive impairments or mild AD.2

Gray suggests rapidly screening patients using the Mini-Cog, or even simple Clock Drawing.3 These can each be administered in less than 5 minutes and have a sensitivity and specificity higher than 80%. He also recommends the use of the AD8; this is a brief informant interview that helps assess problems with judgment, memory, and learning new skills.4
 

References:

References
1. Gray K. No Lobe Unprobed: Mastering the Mental Status Exam. Presented at: US Psychiatric and Mental Health Congress; November 2-5, 2009; Las Vegas.
2. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993;269:2386-2391
3. Borson S, Scanlan JM, Chen P, Ganguli M. The Mini-Cog as a screen for dementia: validation in a population-based sample. Am Geriatr Soc. 2003;51:1451-1454.
4. Galvin JE, Roe CM, Powlishta KK, et al. The AD8: a brief informant interview to detect dementia. Neurology. 2005;65:559-564.