Intended for healthcare professionals

Research

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

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2030 (Published 10 June 2009) Cite this as: BMJ 2009;338:b2030

Is the TYM really a memory test? And some other comments.

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

Competing interests: No competing interests

24 June 2009
Josef Kessler Ph.D.
Professor and Head of Neuropsychology
Markus Luengen Ph.D., and Elke Kalbe Ph.D.
University Hospital, D-50924 Cologne; Institute of Neurosciences and Medicine, D-52425 Jülich