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Detecting dementia in just 12 minutes: the seven minute screen
  1. V W Henderson
  1. Correspondence to:
 V W Henderson
 Central Arkansas Veterans Healthcare System, and Departments of Geriatrics, Neurology, Pharmacology, and Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA and Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia;

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There could be a useful niche for this neuropsychological test

The 11 item mini-mental state examination (MMSE) was devised as a brief yet “thorough” and “practical” assessment of the cognitive mental status.1 It is often used to screen for dementia caused by Alzheimer’s disease and to grade dementia severity. From humble origins three decades ago, the MMSE has become the benchmark against which other cognitive instruments are routinely compared. Alternatives have been proposed to correct perceived limitations of the original; among these psychometric pretenders is the seven minute neurocognitive screening battery, or seven minute screen (7MS).2

The 7MS is a rational concatenation of four tests, each sensitive to the presence of dementia (temporal orientation, cued recall, category fluency, and clock drawing).2 Envisioning a role for the 7MS in clinical practice, Meulen et al compared Dutch translations of the 7MS and MMSE in large outpatient convenience samples in Amsterdam and Maastricht (this issue, pp 700–705).3 The participants, who were referred to specialty clinics for memory complaints, may be different from patients in primary care settings. Exclusion criteria included psychoactive drug use, recent stroke, active neurological or medical disease, and current alcohol abuse. Primary comparisons were with a combined “normal” group: referrals with memory complaints where cognition proved to be intact, plus patients’ relatives and friends without memory symptoms. Normal individuals were similar to demented patients in terms of age and education but probably differed from the general population from which referral cases arose.

The 7MS took about 12 minutes to administer (eight minutes for normal subjects, 16 minutes for patients with Alzheimer’s disease), with additional time required for scoring.3 Analyses were unadjusted for confounders of age, education, or sex, but receiver operator characteristic curves (a useful method of displaying sensitivity and specificity information) favoured the 7MS over the MMSE in distinguishing Alzheimer’s disease patients from normal individuals. Small numbers precluded comparisons between other specific diagnoses and normal subjects, but the 7MS was also superior when applied to an amalgamated non-Alzheimer’s disease dementia group.3 Non-demented patients with depression or other psychiatric diagnoses were often misclassified by both tests. Performance characteristics of the 7MS would certainly be reduced in the complex, messy world inhabited by most clinicians. Here, target populations often include people using psychoactive drugs and patients with depression, neurological or medical disease, or mild cognitive impairment without dementia.

How might the practitioner use the 7MS? This instrument is not intended to assess cognition comprehensively. If the goal is to preselect older patients who might benefit from detailed clinical assessment for dementia, the 7MS clearly outperforms the benchmark MMSE. Although not addressed by Meulen et al, it is likely that the 7MS would also provide a more precise measure of dementia severity in following longitudinal progression. Better sensitivity, specificity, and predictive value should be weighed against a longer administration time and reduced familiarity. It is not known how the 7MS might compare with other validated instruments—for example, the cognitive abilities screening instrument4 or neuropsychological tasks from CERAD (the consortium to establish a registry for Alzheimer’s disease).5

Practitioners should carefully consider the purpose of cognitive screening. For example, clinical assessment for dementia is more commonly triggered by patient or caregiver complaints of cognitive impairment than by screening results. In some settings, however, 12 minutes could be a rewarding investment, suggesting a useful niche for the optimistically named 7MS.

There could be a useful niche for this neuropsychological test