Intended for healthcare professionals


Self administered cognitive screening test (TYM) for detection of Alzheimer’s disease: cross sectional study

BMJ 2009; 338 doi: (Published 10 June 2009) Cite this as: BMJ 2009;338:b2030

A few concerns

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

Competing interests: No competing interests

16 June 2009
Sarah Cuthbertson
Assistant Psychologist
Clinical Psychology, 15 Wetherby Road, Harrogate, HG2 7RY