UAB researchers develop new cognitive screening tool

Researchers at the University of Alabama at Birmingham School of Medicine show that a new screening instrument to measure cognitive deficit is an effective and potentially useful tool for clinicians.

In a paper published in the Primary Care Companion for CNS Disorders, the research showed that the Alabama Brief Cognitive Screener, known as ABCs, is a capable alternative to other screening instruments currently in use to assess the severity of cognitive deficits.

The ability to assess the cognitive state of a patient is an important element both in primary care settings and for specialty medical practices such as psychiatry and neurology. One of the most commonly used tests has been the Mini-Mental State Examination, or MMSE.

“The MMSE was originally developed two decades ago as a means to rapidly measure cognitive function among psychiatric patients, but its ease of use and face validity led to widespread adoption,” said David Geldmacher, M.D., professor in the Department of Neurology at UAB, director of the Division of Memory Disorders and Behavioral Neurology and a study co-author. “Its clinical utility for structured assessment of cognition of older adults with dementia is unquestionable. Unfortunately, use of the MMSE has been hindered by copyright and licensing issues.”

Faced with an immediate clinical need for a nonproprietary screening test that could be incorporated into a patient’s electronic medical record, Geldmacher developed a draft instrument containing 30 items, measuring attributes such as verbal recall, orientation to time and place, calculation, naming, repetition, and figure drawing. The instrument was used and tested by faculty at the UAB divisions of Memory Disorders and Behavioral Neurology and Neuropsychology.

Data were available from 1,589 individuals with an average age of 71 who had a range of conditions including memory loss, mild cognitive impairment and Alzheimer’s dementia.

“The ABCs scores varied appropriately by diagnosis, indicating the test was accurately determining a patient’s cognitive status,” said Giovanna Pilonieta, DDS, MPH, a scientist in the UAB Department of Neurology and study co-author. “The findings showed that ABCs was similar in performance to MMSE between individuals with normal cognition, mild cognitive impairment and Alzheimer’s disease.”

The research team compared ABCs to a large-scale meta-analysis of MMSE, which had produced a mean score for Alzheimer’s patients of 16.08 on a 30-point scale. Although with a smaller sample size, the ABCs produced a mean score of 16.42 for Alzheimer’s patients. The mean MMSE score in mild cognitive impairment was 26.78 against the ABCs score of 25.47.

“This suggests that ABCs and MMSE scores have similar distribution in these clinical populations,” said Marissa Natelson Love, M.D., assistant professor in the Department of Neurology and a study co-author.

The researchers say the ABCs shows promise as an easily administered, nonproprietary alternative to the MMSE for use as a screening instrument to both identify and assess severity of cognitive deficits in medical practice. Although the ABCs is copyrighted, it is intended to remain free and available for use in clinical and noncommercial research use.

“Further characterization of the instrument is underway, including its effectiveness in measuring progression of deficits in patients with neurodegenerative disease and its relationship to instrumental activities of daily living,” Geldmacher said. “Primary care physicians play a critical role in the detection, diagnosis and treatment of people with Alzheimer’s disease and other disorders with cognitive symptoms. Data from the ABCs indicate it might prove a worthwhile tool for expansion of dementia assessment in primary care settings.”

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