Title: Investigation of screening tools for amnestic mild cognitive impairment (a-MCI)
Funder: Department of Health (England)

Abstract: Background: Mild cognitive impairment (MCI) is an emerging clinical syndrome and has been identified as a potentially effective time point for interventions to prevent or slow the decline into dementia. The commonest subtype, amnestic-MCI (a-MCI), characterised by cognitive impairment primarily in the memory domain, is associated with a high risk of Alzheimer’s disease and has therefore received clinical and research interest. In order to conduct large scale, population based intervention studies in people with a-MCI, an important first step is to develop an approach to identify people with a-MCI which is reliable and efficient. A widely used and internationally accepted diagnostic standard for a-MCI is the Petersen criteria. However, these require a complex and specialist-based assessment procedure that is very time consuming. Shorter, less arduous cognitive testing procedures would provide a more resource efficient and feasible method to identify people with probable a-MCI for participation in large scale, pragmatic a-MCI intervention studies. Two candidate cognitive assessment instruments are the Memory Alteration Test (M@T) and the Test Your Memory (TYM) test. Aims : To evaluate the clinical utility and sensitivity/specificity of the M@T and TYM for identifying people with probable a-MCI in a primary care setting by addressing the following research questions: Are the M@T and TYM sensitive and specific in detecting a-MCI in community-based populations? Are the M@T and TYM reliable measures? Are the M@T and TYM feasible for use in community based populations? Plan: Participants will be recruited from NIHR research-ready GP practices in Bradford. Eligible participants will be selected via electronic record screening, followed by a screening letter and finally telephone enquiries. Participants with subjective memory impairment, no depressive symptoms, and who have a potential informant will be invited to consent to study participation. Participants will first be visited at home and asked to complete either the TYM or M@T. They will then be invited to attend the Bradford Clinical Research Facility and asked to complete either the M@T or TYM (the alternative to that completed during the home visit). Following this, the cognitive assessment questionnaires/tests for the operationalised Petersen criteria will be conducted with the participant and their informant. Scores from this will be used to classify participants as cognitively normal, a-MCI, possible early dementia or other (including people with non-amnestic MCI). A sample of participants will be visited at home again to complete either the M@T or TYM to enable the test-retest reliability of the instruments to be investigated. Using recommended cut-off scores, the sensitivity, specificity, positive and negative predictive values and likelihood ratios will be calculated for the M@T and TYM for differentiating a-MCI from cognitively normal, and for differentiating a-MCI from possible early dementia. Reliability will be assessed for both the M@T and TYM by comparing scores for the two assessments. Clinical utility of the M@T and TYM will be assessed by examining administration times, missing items and completion rates. Benefits: Identifying a screening instrument for the detection of people with probable a-MCI will facilitate research aimed at developing, testing and implementing drug, lifestyle and carer interventions to prevent or delay the decline into dementia. Additionally, management plans and care pathways for people with a-MCI can be developed. If a-MCI interventions prove successful, a reduction in the economic burden of dementia which, in the UK, currently exceeds that for stroke, heart disease and cancer combined, might be expected. Moreover, the identification of a simple instrument may allow GPs at a future time to routinely screen for a-MCI, allowing the timely referral of patients for further cognitive assessment if required.


Research activity codes: 4.4 POPULATION SCREENING
Health categories: NEUROLOGICAL