Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
TYM test accurate?
- Michael R Barratt (10 June 2009)
-
Cultural bias
- Aileen Wiglesworth (11 June 2009)
-
TYM test: too many false positives
- Stephen L. Black (11 June 2009)
-
Age profile?
- Rosaleen A. McCarthy (11 June 2009)
-
TYM promising, but really specific?
- Antonio E Segovia (11 June 2009)
-
Re: TYM test: too many false positives
- Harry Hall (12 June 2009)
-
Re: Cultural bias
- Kevin R Smith (14 June 2009)
-
Pedantic Scoring
- Kevin R H Smith (14 June 2009)
-
89 year old patient - diagnostic differential&treatment
- John D Herman (15 June 2009)
-
Re: TYM test: too many false positives
- Joan McClusky (15 June 2009)
-
A few concerns
- Sarah Cuthbertson (16 June 2009)
-
Further testing of 'Test Your Memory Test' is needed
- Louise Robinson, Carol Brayne, Steve Iliffe on behalf of the Primary Care Clinical Studies Group, Dementia and Neurodegenerative Diseases Research Network (19 June 2009)
-
Is the TYM really a memory test? And some other comments.
- Josef Kessler Ph.D., Markus Luengen Ph.D., and Elke Kalbe Ph.D. (24 June 2009)
-
A methodological fallacy?
- Akshya Vasudev (2 July 2009)
-
If the patient is illiterate?
- Nazan Karaoglu (3 July 2009)
-
Authors' reply
- Jeremy Brown, George Pengas, Kate Dawson, Lucy A Brown, Philip Clatworthy (9 July 2009)
-
First of a kind
- Andrew S. Hua (12 July 2009)
-
I would very much to see the actual TYM test
- Robert K Johnson (5 September 2009)
-
Obtaining copies of test
- Edward W BEAL (10 October 2009)
|
|
|||
|
Michael R Barratt, retired 48 Punch copse road Crawley RH10 1Qz
Send response to journal:
|
The below question is posed in a generic context: My father is 89 years of age and has suffered lapses in memory for many years, a condition that has grown progressively worse over the years. In 1943 he was involved in a motor accident and as a result suffered a fractured skull, an injury in respect to which he has received an 80% war pension since 1946. Can the TYM test with any practical degree of accuracy differentiate between a patient with Alzheimer’s disease and a patient with memory loss initially due to trauma and deterioration over time? Competing interests: None declared |
|||
|
|
|||
|
Aileen Wiglesworth, Assistant Clinical Professor Program in Geriatrics, University of California, Irvine, 90806 USA
Send response to journal:
|
This tool is needed and I congratulate the authors, but I would be reluctant to use it with my American research participants. I see in the discussion that you plan to develop an American version and others. Of course it's easy enough to ask about the President rather than the Prime Minister, but the other problematic items would need testing since a one for one swap of the problematic items is not obvious. I refer to the sentence (Americans do not talk of "stout shoes" - and I, for one, found the phrase quite memorable for that reason), and the WWI question (Americans not only entered the war in a different year, but we are less knowledgeable of history in general than Europeans). These seem to me to require more than "minor" adjustments, but rather the changes that will require validation in sample populations. I'll be interested to see what is put forward and hope you will convince me otherwise. You provide no data on the ethnic make-up of your sample - were there exclusionary criteria to ensure a British, non-immigrant, sample? Competing interests: None declared |
|||
|
|
|||
|
Stephen L. Black, retired (emeritus) professor of psychology Bishop's University, Sherbrooke, Quebec J1M 1Z
Send response to journal:
|
Brown et al (1) report 93% sensitivity and 86% specificity for their self-administered screening test for Alzheimer’s disease. They conclude that “it is a powerful and valid screening test for the detection of Alzheimer’s disease”. According to Gigerenzer (2), as expressed in the pages of this journal and elsewhere (3), doctors and laypeople are often confused by such conditional probabilities. He advocates that the value of a screening test is best appreciated when statistics are expressed in natural frequencies. I am surprised that Brown et al did not do this in their paper. For infrequent disorders, even high values of sensitivity and specificity can lead to an unacceptable number of false positives. The accompanying editorial (4) gives an expected prevalence of 13 cases of Alzheimer’s in 1000 people aged 65-69. Using this as the base rate together with the figures for sensitivity and specificity, I calculated test results in natural frequencies. It turns out that for every individual correctly declared to have Alzheimer’s disease, about 11, on average, will be falsely declared to have this dread disease. This test is likely to become popular among doctors and laypersons given its ease of administration and the frequency with which the important question “Do I have Alzheimer's” arises. The dissemination of the test would be unfortunate, because the potential for misunderstanding of its results is high, and will cause many people to incorrectly self- assess or be told that they have a cruel disorder for which there is no hope. 1. Brown, J., et al. Self-administered cognitive screening test (TYM) for detection of Alzheimer’s disease : cross sectional study. BMJ 2009;338:b030 2. Gigerenzer, G. and Edwards, A. Simple tools for understanding risks: from innumeracy to insight. BMJ 2003;327:41-744 http://bmj.com/cgi/content/full/327/7417/741 3. Gigerenzer, G., et al. Helping doctors and patients make sense of health statistics. Psychological Science in the Public Interest 2007;8:no. 2 http://www.psychologicalscience.org/journals/pspi/pspi_8_2_article.pdf 4. Nicholl, C. Diagnosis of dementia. BMJ 2009; 338:b1176 http://www.bmj.com/cgi/content/extract/338/jun08_3/b1176?papetoc Competing interests: None declared |
|||
|
|
|||
|
Rosaleen A. McCarthy, Professor and Head of Neuropsychology Southampton General Hospital SO16 6YD
Send response to journal:
|
The authors are to be congratulated for producing a novel and useful collection of tests for screening the early stages of Alzheimer's disease. As a very busy clinical practitioner I especially welcome the "self administered" aspects of the test's design and I wish them every success in obtaining the necessary support for taking this important work forward. However, in reading the article I was unclear as to why the authors had incorporated so many young people in their cross-sectional control sample (including 18 year old volunteers whose risk of Alzheimers is infinitesimal). The presence of ceiling effects and age effects in the control data means that younger people will be more likely to score at the top of the scale - and the psychometric properties of the TYM could be unwittingly distorted by the inclusion of so many junior participants. The authors report that older people with presumed Alzheimer's disease showed a tendency to score more highly than younger people. They also report that their older controls tended to fare worse than younger people. This is worrying. Fortunately, the pairwise statistical comparisons between age-matched controls and suspected Alzheimer's cases are reassuring. However, it would be very helpful if the the authors' TYM web pages could include cut-off scores/percentile distributions and ROC curves for the age groups at highest risk. Competing interests: None declared |
|||
|
|
|||
|
Antonio E Segovia, Consultant Psychiatrist King George V Hospital, South Barracks Rd, Gibraltar
Send response to journal:
|
TYM seems to be a very promising test with lot of advantages to be used in clinical setting. The main question is if the test is really specific to discriminate Alzheimer's disease versus other forms of dementia in clinical practice. The published samples are very small particularly the group of "other forms of dementia and mild cognitive impairment" only 31 patients that includes 16 patients with Lewy bodies dementia, 13 with frontotemporal dementia and 2 with supranuclear palsy, none with vascular dementia. Each form of dementia can present with a different degree of severity; is the test specific enough to discriminate Alzheimer's disease versus other forms of dementia that can present at different degrees of severity?. Let's say if a patient scores 41 in the TYM how confidently can we assume that he/she suffers from Alzheimer's disease and not from other form of dementia? Alzheimer's disease and vascular dementia sometimes intermix what is the discriminatory power? What is the predictive value for a score below the cut off point? Competing interests: None declared |
|||
|
|
|||
|
Harry Hall, Retired physician Exeter EX1 2HW
Send response to journal:
|
Prof. Black is quite right. The test as it stands may be quite good at ruling out Alzheimer's if the test is negative- one false negative for 900 or so true negatives- but has an appalling odds for positive tests. Results ought really to be given in the form he advocates, or for those keen on it, as predictive value for positive and negative tests. Care is needed with the latter parameter as it refers to the odds of NO DISEASE with a negative test in the whole population- ridiculously incompatible with its analogue, Negative likelihood ratio,the odds of DISEASE with a negative test in a population consisting of equal numbers of diseased and non-diseased. As with all test interpretations, the "cost" of false negatives and false positives should be taken on board. Explain all this to someone in the early stages of dementia, or indeed any doctor! Competing interests: None declared |
|||
|
|
|||
|
Kevin R Smith, Consultant Occupational Physician Co Durham & Darlington NHS Foundation Trust
Send response to journal:
|
I don't think the stout shoes point is as big an issue as the responder thinks - I'm white English causcasian and I'm not aware that my cultural group talk of stout shoes either. In fact we don't talk of citizens much, though this is starting to creep up on us. I too found it quite a memorable sentence for this reason. Competing interests: None declared |
|||
|
|
|||
|
Kevin R H Smith, Consultant Occupational Physician County Durham & Darlington NHS Foundation Trust
Send response to journal:
|
Our family just completed the TYM in competitive style and quick time. The eldest (74) claims to have the highest score and a difference of opinion arose regarding how one marks the position of the hands on the clock. Does one insist that the candidate completes the hour hand (the short one) so that it points about one third of the way from 9 to 10 on the clock - as would be most accurate or is it good enough to point it at the 9! No such difficulties arise with the minute hand (the long one) which just points at the 4. Another difficulty arises in that we had heard a bit about this on the news which meant we had all had plenty of practice on animals beginning with 's' and had managed to ascertain that whilst some scorers would accept anything not vegetable or mineral as an animal, others wished to exclude, on spurious grounds, such creatures as reptiles and fish as not being animals. After that preparation none of us was about to struggle for inspiration or tempt fate with a 'sausage dog' (daschound). Our scores: LL (Age 74), 49; SL (Age 70), 48 or 49 depending on the clock hand question; KS (Age 45), 49 or 50 depending on the clock hand question. Competing interests: Personal pride is at stake |
|||
|
|
|||
|
John D Herman, Ph.D., APRN, BC, Psychiatry Private Practice 1013 Grandview Dr Hudson WI 54016 USA
Send response to journal:
|
I assume that this patient has had multiple workups for the traumatic brain injury both post occurrence and multiple measurements, diagnostic imaging etc., throughout the years. Firstly, a prime issue for me at this patient's lifestage is that this test is of little value except perhaps nosologically or in a research scenario. Secondly, if this were my patient, my prime concern is not the diagnosis, but the quality of life in which treatment is framed primarily using family,friends, and day-to-day caregivers as collateral reporters - this would be of the greatest importance in maximizing the quality of life. In my view, the geriatric psychiatrist role here is in overseeing treatment, insuring coordination of care systems however that needs to occur, and insuring that polypharmacy, if any, is minimized as reasonably possible.It seems possible, though unlikely that the TYM would be of little or no value in treatment planning, given the severe history and heavily overlapping symptoms that are likely. Competing interests: None declared |
|||
|
|
|||
|
Joan McClusky, Medical writer New York, NY 10003
Send response to journal:
|
Regarding Prof. Black's calculation of 11 false positives for every correct diagnosis of Alzheimer's disease: many screening tests, such as mammography, have been criticized for producing too many false positives that generate worry and unnecessary intervention. One can only imagine the anguish a false diagnosis of Alzheimer's disease would generate. It is disturbing that this information--which must surely be considered in implementation of the test, as well as patient counseling--was not included in the study itself, but owes it reporting to Prof. Black. The fact that it takes only 5 minutes and a pencil to produce such worrisome results is even more disheartening. At least with mammography, time, cost, availability, and risk are factored into its use. I would strongly urge that anyone taking the test, or their caretaker, be required to read and sign a statement indicating they understand that 11 people are falsely diagnosed with Alzheimer's for every person correctly identified. In other words, the potential for good news, even with a "bad" result, vastly outweighs the probability for genuine bad news. I would also recommend that there be a clear list of other tests that will or can be done to more accurately diagnose Alzheimer's, particularly at an early stage, and that no action be taken in terms of treating, counselling for care, or anything else until a more accurate diagnosis is established. This is particularly important in nursing homes, where such screening may become widespread and patients with reversible problems may simply be lumped into the "Alzheimer's group." Competing interests: None declared |
|||
|
|
|||
|
Sarah Cuthbertson, Assistant Psychologist Clinical Psychology, 15 Wetherby Road, Harrogate, HG2 7RY
Send response to journal:
|
The Test Your Memory (TYM) test has been designed as a tool to be quick to administer by a non specialist, test a range of cognition and be accurate in diagnosis of Alzheimer’s. It was created as an improvement to the current “gold standard” test the Mini Mental State Examination (MMSE). However, I have several concerns regarding the TYM test. Firstly the issue of consent with testing does not appear to have been thought through. When conducting testing, consent must be given to carry out the test and the implication of any possible outcomes, good and bad made explicitly clear. Will consent be discussed with the individual before they start completing the TYM test in the waiting area? Who will do this if they are not seeing the medic until the have completed that test? As well as this, the fact that the test is completed by the individuals unsupervised or – as the article suggests – with the receptionist supervising them in the waiting area needs to be considered. As this test includes the clock drawing test, will all clocks be removed for waiting areas where the test is being carried out? Will the supervising receptionist be able to stop them looking at their own watch or indeed preventing anyone who chooses to cheat from doing so? Or will the carer have to responsibility to ensure that the individual does not cheat? If this is the case, this adds more stress to an already stressful job. It is also worthwhile noting that confidentiality is also a large issue if cognitive assessments are being suggested to be completed in an open public area. Furthermore, in administering the test with the individual, large amounts of qualitative information can be gathered and noted when scoring and interpreting the test. Looking for signs of anxiety when completing to the test to see if this is a factor in the interpretation of the test score for example. If the tests are completed without an observer to take in this type of information, I fail to see how the TYM can do as it claims, offering “thorough testing in minimal time“ by having the individuals complete the test themselves. In the TYM test is has some prompts that I feel deny the collection of interesting data. By offering the individual the prompt in the year of “20—“ this will automatically help orientate to the year. Some of the most interesting qualitative data that can be found from testing is in the free recall of the orientation data. If the year recalled is inaccurate, it can give an indication of possibly when the cognitive problems started to occur, or to an important time in that person’s life. Using the question “when did the first world war start?” to test recall of remote information is culturally specific and possibly not relevant for some younger adults that may be experiencing the beginnings of memory problems. I note that the authors of the TYM test state that they will change the wording on the question ‘Who is the Prime Minister’ so that is relevant in other cultures. It is worthwhile applying a modification to the First World War question too? Finally I would like conclude that brief testing is no substitute for thorough testing conducted by professional in the appropriate environment. While I accept that due to time pressure on services, shorter tests such as the TYM test are very helpful. However, it seems remiss of us to be losing out on useful information that can be gathered by simply taking some time to administer tests with the individual ourselves. Competing interests: None declared |
|||
|
|
|||
|
Louise Robinson, Chair; Primary Care Clinical Studies Group, Dementia and Neurodegenerative Diseases Research Network Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AA, Carol Brayne, Steve Iliffe on behalf of the Primary Care Clinical Studies Group, Dementia and Neurodegenerative Diseases Research Network
Send response to journal:
|
Dear Sir, the recent publicity generated by the article on the test 'test your memory (TYM)'(1)highlights intense general interest in early and accurate recognition of dementia, usually Alzheimer's disease. Although the TYM is 'self administered' it was given out by clinic staff to clinic attendees in a setting to which people had been referred with comparisons provided for defined clinical subgroups; the people filling in the questionnaires had already been through at least one filter and seen their gp. They were also seen immediately afterwards by a clinician who could address any concerns. The danger of calling a test 'self administered' in the title is that it provides a very different and potentially misleading message - that of downloading the test from the internet and doing it in the home setting with no forum for interpretation or provision of support; the diagnosis of dementia is a process which requires multidisciplinary assessement and often over a period of time(2). Many older people are now asking their doctors whether they should get and do the test. In addition, the TYM was administered to a relatively young population (median ages under 70) with potentially high educational levels; memory clinic referrals have not been demonstrated to be representative of the general older population. It is uncertain exactly how much advantage it provides over MMSE as the full MMSE ROCurve was not provided. These factors mean that it would be unwise to assume it would perform as well in the very different settings such as general practice waiting rooms or at home. If this is the intention of this test it must be applied in many different and appropriate settings, with longitudinal follow up to ensure validity, as well as appropriate support to those completing it. All this has to be done before any suggestion that this might be a useful test in any more extended settings for early detection of Alzheimer's disease or dementia. 1. Brown, J., et al. Self-administered cognitive screening test (TYM) for detection of Alzheimer’s disease : cross sectional study. BMJ 2009;338:b030 2. Nicholl, C. Diagnosis of dementia. BMJ 2009; 338:b1176 http://www.bmj.com/cgi/content/extract/338/jun08_3/b1176?papetoc Competing interests: None declared |
|||
|
|
|||
|
Josef Kessler Ph.D., Professor and Head of Neuropsychology University Hospital, D-50924 Cologne; Institute of Neurosciences and Medicine, D-52425 Jülich, Markus Luengen Ph.D., and Elke Kalbe Ph.D.
Send response to journal:
|
Test your memory (TYM) is a self-administered cognitive screening test for detection of Alzheimer´s disease (AD). The test takes about 5 minutes for healthy subjects; information on test duration in demented subjects is missing, but it is considered to be an economic test. Some important comments should be made: The first one refers to the relevance of memory impairment for dementia. In the TYM there is only one sentence which has to be copied and recalled afterwards, making only 6 out of 50 possible points for the episodic memory domain – next to orientation, calculation, visuospatial abilities etc. Secondly, a major limitation of the TYM is the missing evidence for performing the test without help in a waiting room. What happens if help is needed? Should the test be stopped? What happens with the delayed recall of the only real episodic memory item? Will a severe bias of the individuals eligible for screening occur? Looking at the items it is evident that healthy subjects and MCI patients will usually be able to handle the tasks, but will Alzheimer patients be able to do this? The authors report a sensitivity to detect AD of 92% and a specificity of 84% when applying a cut-off score of 43 out of 50 points. The diagnosis of the patients included was based on examinations in three hospitals including a memory clinic. The test then identified AD patients because they have the most severe impairment. However, patients with MCI might only have problems with the one item testing episodic memory and not with semantic memory. Furthermore, comparisons of patients with dementia of different aetiology are missing, especially of patients with vascular dementia. Furthermore, experience of test administration by general practitioners would be important. Another important aspect is that the test is language based and can only be administered when the subject is able to read and write. However, a considerable number of functional illiterates exist, and another amount of people may not speak the language due to different reasons. For these subjects, the test is not valid and perhaps not even applicable. Competing interests: None declared |
|||
|
|
|||
|
Akshya Vasudev, Specialty Registrar 5, Old Age Psychiatry Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Newcastle NE1 7RU
Send response to journal:
|
The Brown et al (1) study has generated intense discussion, not only by clinicians, but very appropriately, by lay people as well. The study was designed well in most repsects; some of the shortcomings have already been highlighted in the rapid responses so far. I would like to highlight another fallacy which has not yet been commented upon. This study was conducted in a memory clinic environment in Cambridge on patients suffering from dementia, mostly of Alzheimer’s type as per NINCDS-ARDRA criteria. The authors mention that patients with depression were excluded, presumably based on a diagnostic assessment by the psychiatrist. I would like to comment on the validity of the screening test, as an important subgroup of patients has been excluded. Most memory clinics would have a substantial number of patients who present with cognitive impairment due to depression rather than dementia. It is vitally important to know how these patients fared on the TYM test as the specificity of the test to delineate dementia from depression would be crucial. The authors sadly have not furnished this data/have not attempted to explore this in the paper. Professor Black has already commented on the high number of possible false positives in patients who underwent the TYM. If there is a high false positive rate in patients with depression as well, it will further reduce the validity of the TYM test. The authors also quote that they have been able to demonstrate very high sensitivity and specificity of the TYM test, 93% and 86% respectively. However, studies using other cognitive screening tests eg. the modified Danish version of the ACE have found similar, if not better, sensitivity and specificity (99% and 94% respectively) (2). The above paper(2) did though mention that specificity dropped to 64% in patients with depression. This again highlights the need for a screening test to differentiate between depression and dementia, which is as yet not readily available. 1.Brown, J et al. Self administered cognitive screening test (TYM) for detection of Alzheimer’s Disease: cross sectional study. BMJ 2009;338:b030 2. Validation of the Danish Addenbrooke's Cognitive Examination as a screening test in a memory clinic. Stokholm J, Vogel A, Johannsen P, Waldemar G. Dement Geriatr Cogn Disord. 2009;27(4):361-5. Epub 2009 Mar 20. Competing interests: None declared |
|||
|
|
|||
|
Nazan Karaoglu, Assistant professor, MD Medical Education and Informatics Department, Meram Medical Faculty, 42080,Konya,
Send response to journal:
|
Dear sir, I read the interesting article of Brown et al. and other rapid responses. I want to ask about the effect of educational level of patients on the test. In my country illiteracy is common especially in the elderly group and I think this is a problem of many countries. Authors mentioned about disabled people or patients with hearing loss or eye problems but if a patient is illiterate which category of help should be assigned? With my respects, Competing interests: None declared |
|||
|
|
|||
|
Jeremy Brown, Consultant Neurologist Department of Neurology, Addenbrooke’s Hospital, Cambridge CB2 2QQ, George Pengas, Kate Dawson, Lucy A Brown, Philip Clatworthy
Send response to journal:
|
There has been much interest in the publication of the new cognitive test “Test Your Memory (TYM)”. We have received many positive comments but there has been some misinterpretation of our findings. The TYM test is intended to be self- administered by the patient and this is a central feature – as it allows testing of 10 cognitive skills in minimal operator time. The TYM test needs to be overseen and interpreted by a health professional. The test is therefore self-administered but not for self diagnosis. It is hard to choose an alternative title which clarifies this without being too long. As a result of the publicity concerning self testing we have delayed the launch of the website tymtest.com until we can ensure easy access for professionals whilst discouraging self testing. The TYM test has been validated in a single study in a single population who have presented with cognitive problems. It shows great promise as a screening tool in this setting. Some of the replies highlight problems that would occur with indiscriminate screening of asymptomatic patients, where the number of false positives would cause many problems. We would agree that such testing is not appropriate. A low TYM score suggests the need to look for a cause (which can be as simple as leaving spectacles at home), it does not mean the patient has Alzheimer’s disease. We agree that the TYM test needs to be validated in other populations. Longitudinal data is crucial and is being collected. The TYM test is not a diagnostic test. The diagnosis of Alzheimer’s disease needs a proper clinical assessment from a trained professional. The TYM test is an aid in this process but not a replacement for it. Human beings and brain diseases are inherently variable and it is unlikely that there will ever be a quick memory test which would allow an untrained person to safely diagnose Alzheimer’s disease or distinguish Alzheimer’s disease from other forms of degenerative or vascular dementia. An experienced clinician may recognize a pattern of scoring on the TYM which suggests Alzheimer’s disease or semantic dementia in many patients. The TYM test can be completed quickly by most patients and be supervised by an individual who has received minimal training. This is not the same as saying that it should be done in a busy room or casually. The patient should give verbal consent, be sat in a quiet area away from other patients, clocks and newspapers and the supervisor will need to help if necessary. In many of the clinics where we have used the TYM, certain nurses or receptionists have proven very competent at supervising the test and there has been a suitable area. If this is not possible or there is more time then we supervise the test ourselves. We would agree that there are clear advantages in the clinician supervising the test. Whilst this will take up 5 minutes of the clinician’s time watching the patient often yields more information and we usually find it possible to do some other tasks such as reading notes or filling forms at the same time. The TYM test as published is culturally biased. A major advantage of the TYM test is that it can be translated and adapted for many other cultures and languages without changing the basic structure. Over a dozen different language/cultural versions are under preparation; these different versions of the TYM test will also need to be validated. We hope to place these on the website tymtest.com. We are also working on versions of the TYM suitable for patients with visual impairment and physical disabilities. In answer to more specific points, we include a wide age range of controls because many younger patients have cognitive complaints as a result of epilepsy, multiple sclerosis and other conditions and we believe the TYM test may be useful in these patients. The average TYM scores of controls are remarkably stable but do fall off after the age of 70 years as do most similar tests. There were no significant differences between older and younger patients with Alzheimer’s disease. The use of occasional prompts is to try to make as clear as possible to patients the answer required – so that failure to complete a space properly is because the task couldn’t be done not that the patient was unsure of what was required. We are well aware of the ethical debate around early diagnosis of Alzheimer’s disease and share many of the concerns of your correspondents. It is vital, in our opinion, that progress is made towards early diagnosis for several reasons; one important reason is that if a treatment which halts Alzheimer’s disease becomes available, we need a test to identify those likely to benefit. Competing interests: None declared |
|||
|
|
|||
|
Andrew S. Hua, Consultant Physician and Geriatrician Melbourne, VIC 3103, Australia
Send response to journal:
|
Congratulations to Drs. Brown et al. for bringing out what will prove to be a prototype for easily administered screening test for a looming epidemic of cognitive diseases in the elderly. All the comments are valid criticisms and point towards the difficulty of any tests of this kind. What we need is a well validated test across different languages educational levels age groups and cultures which can be easily administered and non-confrontational. With the availability of new gadgets like the iphone, it would quite conceivable to develop such a test as a freely downloadable application in different language forms and include tests for attention, reaction time etc. which can be significant for diseases such as Lewy Body Dementia (DLB), which ranks second to Alzheimer disease in the over 75s. I agree that interpretation should be left to clinicians and the results should be referred back to a central reference databank where they can be analysed against age, gender and ethnic norms, and reported only as within a certain percentile of the normal range. It is about time tests such as the MMSE are replaced - the gold standard lining the pockets of the copyright holders. Competing interests: None declared |
|||
|
|
|||
|
Robert K Johnson, Physician 4 Woodrun,
Send response to journal:
|
Although I primarily perform Orthopoedic consultantations, I am interested in this test and reasonably would employ it in my practice. I have read several pages about it but no method of directly obtaining it for review. In my opinion, it probably deserves a place in office practice and should be considered as a valuable screening asset for practitioners. I would like to review it for my own practice. Pleasse advise me how to obtain a copy of the TYM test Thank you Robert K Johnson MD KY 41892 USA Competing interests: None declared |
|||
|
|
|||
|
Edward W BEAL, clinical professor of psychiatry 20852
Send response to journal:
|
this is a very interesting article. I would like to obtain a copy of the test for use in my office. How may I obtain one? Thanks you Edward W Beal, MD Competing interests: None declared |
|||