New 5-minute Memory Orientation Screening Test to identify elderly patients with dementia

Dec 10 2010

A new 5-minute test to identify elderly patients with dementia promises to give doctors a more sensitive tool to use in the Annual Wellness Examination. The Memory Orientation Screening Test (MOST™) developed by Mitchell Clionsky, Ph.D., a neuropsychologist, and Emilymarie Clionsky, MD, an internist/psychiatrist, is based on their clinical experience with thousands of patients who suffer from Alzheimer's Disease and other dementias, which now afflicts more than 5 million Americans.

The MOST combines recall of new information, orientation to time and date, and clock drawing into a single score that can accurately determine if someone has cognitive impairment and its severity. The test takes less than five minutes to give and can be administered by a range of support personnel, freeing up the doctor's time to discuss the results with the patient and their family. This research, published in the December 2010 American Journal of Alzheimer's Disease and Other Dementias (http://aja.sagepub.com/content/25/8/650.abstract) studied a group of over 700 patients who took the MOST as part of a large battery of cognitive tests and family interviews.  Data analysis found the MOST to be more reliable over time and more accurate in identifying cognitively impaired patients than either the Folstein Mini Mental State Exam or the Mini-Cog, the two tests most frequently used by doctors in their offices to test for memory loss. The MOST also measures changes in a patient's memory over time. This permits the doctor to identify progressive loss or positive responses to treatment.

"Doctors are the first line of detection for changes in brain functioning, but they need a better tool to use in their offices. We designed the MOST to be fast, accurate, and accepted easily by older patients," said Dr. Mitchell Clionsky. "Because patients are often unsure about whether their forgetfulness is normal or is an early sign of deterioration, you can't just ask them how they are doing. By the time it becomes obvious to the doctor, the disease has gotten worse and the patient has lost abilities that might otherwise be saved."

A screening test is especially important, according to Dr. Emily Clionsky, because early detection means earlier treatment with medications that can slow down or stop the progression of memory problems. Dr. Clionsky pointed out that, starting January 2011, primary care doctors are required to identify cognitive problems as part of a Medicare patient's Annual Wellness Exam. "Now they will have a better tool that is faster, simpler and more accurate. This will improve their ability to decide who needs more testing, who can be watched a little longer without taking action, and who can be reassured that it is just a 'senior moment'. This Annual Wellness Visit is a perfect time for a doctor to take stock of a patient's cognitive level as another important part of their overall health." She also pointed out that, "as patients get used to this kind of testing, it will be as routine as having their blood pressure taken or stepping on the scale." Dr. Clionsky notes that she has been using the MOST in her clinical practice for the last three years. "I can show a patient and their family how they are doing in a way that is objective and gives us guidance for the next step in treatment.  It does not take the place of extensive neuropsychological testing, but gives a busy practitioner the next best thing."

Because dementia increases the risk of patients forgetting to take medicine for other conditions, the value of identifying cognitive difficulty impacts virtually all other areas of health. "For example, we now  know that patients with cognitive impairment are at higher risk for delirium after having hip or knee replacements," notes Dr. Clionsky.  "If we routinely test older patients before this type of surgery, we can take steps to minimize bad outcomes. By measuring cognition we can achieve better medical outcomes and save health care dollars overall."