Memory for Intentions Screening Test
- 1. Memory for Intentions Screening Test Abstract Early detection of dementia may help slow the progression of the illness and increase treatment efficacy. The Memory for Intentions Test (MIST) was given to older individuals who did not exhibit dementia. They were re-tested one year later to determine if first testing significantly predicted those individuals that converted to a diagnosis of dementia. One year after initial testing participants were administered the Dementia Rating Scale-2 (DRS-2) and Alzheimer’s Disease Assessment Scale (ADAS-Cog). A forward stepwise logistic regression analysis was conducted to predict performance on the DRS-2 using the summary score from the MIST and other measures. Prediction success overall was 75%. Neuropsychological measures are easily obtained and well tolerated. The use of a neuropsychological measure that accurately predicts conversion to dementia would be helpful for early treatment and management Introduction Early detection and intervention for people with dementia may help slow the progression of the illness and increase treatment efficacy (Peterson et al, 1999). There are several methods that have shown promise for the early detection of cognitive decline. These include functional neuroimaging techniques and analysis of biomarkers in cerebrospinal fluid (Kadir and Nordberg, 2010; Wierenga and Bondi, 2007). However, these techniques are expensive and not as yet readily available to the general public. On the other hand, neuropsychological measures are easily obtained and well tolerated. One area that appears particularly promising is prospective memory (PM), the ability to remember to do something in the future (Raskin et al., 2010). Preliminary evidence suggests that PM may be sensitive to the onset of dementia, possibly reflecting decreased self- initiation, attention switching of attention, or inhibition on memory tasks because of early involvement of the frontal system in MCI and AD (Huppert and Beardsall, 1993; Kazui et al, 2005; Jones et al, 2006; Troyer & Murphy, 2007; Blanco-Campal et al, 2009; Costa et al, 2010 ). To date, these studies have relied on a few PM tasks embedded in the Rivermead Behavioral Memory Test (RBMT) (Huppert and Beardsall, 1993) or idiosyncratic experimental tasks (Troyer & Murphy, 2007). Jones and colleagues (2006) found that event-based PM deficits are also sensitive to predicting cognitive decline to AD and that PM deficits are more accurate to predicting cognitive decline than retrospective memory deficits. However, no study has used a standardized objective measure of PM to examine this hypothesis. Previous research with a standardized measure PM, the Memory for Intentions Test (MIST) has suggested that it is may be effective in identifying PM deficits in patients with amnestic MCI (Troyer & Murphy, 2007; Karantzoulis et al, 2009) and has been related to activities of daily living in older adults (Woods et al., 2012). In the present study we used the MIST to determine whether it could be a quick and effective screening tool to predict conversion to AD in older individuals with MCI. David Correll, Damien DeCuir, Colin MacKichan, and Sarah Raskin Psychology Department, Trinity College Participants Thirty participants between the ages of 20 and 80 were included. Older participants were recruited from a nearby senior center and a memory disorders clinic. The exclusion criteria consisted of a current dementia diagnosis (ruled out by the Mini Mental State Examination (MMSE, Folstein et al, 2000) and medical record review), history of neurological or psychiatric illness, significant cardiac or pulmonary illness, significant hearing or visual loss, a Beck Depression Inventory-II (BDI-II) (Beck, Steer & Brown, 1996) score >15, a Beck Anxiety Inventory (Beck & Steer, 1993) > 25 or a Global Deterioration Scale (GDS) score >10. The Trinity College Institutional Review Board approved the study. Neuropsychological Measures Neuropsychological measures included the Tower of Hanoi (Sanzen Neuropsychological Assessment Tests), Controlled Oral Word Association Test (Loonstra et al., 2001), Hopkins Verbal Learning Test (HVLT; Brandt & Benedict, 2001), and the Logical Memory and Visual Paired Associates subtests from the Weschler Memory Scale- Revised (WMS-IV; Wechsler, 2009). Prospective memory was assessed using the Memory for Intentions Screening Test (MIST, Raskin et al., 2010) and the Comprehensive Assessment of Prospective Memory (CAPM; Waugh, 1999) self report survey. All participants received all neuropsychological measures in one testing session of approximately 2 hours. One year after initial testing participants were administered the Dementia Rating Scale-2 (DRS-2) (Mattis, 1988) and Alzheimer’s Disease Assessment Scale (ADAS-Cog) (Rosen et al., 1984) to determine if any participants have converted to Alzheimer’s disease. Results The only neuropsychological measure that correlated with the MIST was the Tower of Hanoi. A forward stepwise logistic regression analysis was conducted to predict score on the DRS using variables found to be significant in the correlational analysis: the summary score of prospective memory ability from the MIST, the Tower of Hanoi and Hopkins Verbal Learning Test. A binary variable was created for the DRS with a cutoff of 129. Neuropsychological variables were entered in block one and summary score from the MIST was entered in block two. A test of the model was statistically significant, indicating that the predictor as a set reliably distinguished between individuals having a total DRS of less than 129 with those having a higher score. Prediction success overall was 83%. The Wald criterion demonstrated that Total on the MIST made a significant contribution to prediction (p _ .008). The remaining tested variables were not significant predictors. Subsequent analysis revealed that a MIST Summary Score cutoff of 18 produced the strongest (86%) accuracy for grouping older individuals into those likely to develop dementia and those not on the cusp of developing dementia. Discussion Based on these findings, MIST performance appears to be sensitive to age-related changes in PM. MIST appears to be related to both medication adherence and self-report in a healthy population. It was also shown that age, even in young-old individuals, appears to be related to modest deficits in time-based prospective memory. The study also reaffirmed former conclusions reached. It provided additional support for executive deficits underlying poor performance. The study also further supported the assertion that prospective memory performance may be an early indicator of cognitive decline with age. However effective the study was, a few limitations existed. It did not comprehensively determine neuropsychological status to ensure all were cognitively intact at first testing. Due to the fact that all event-based tasks have cues and items related, the attentional control demands were lowered. It is also possible that there exist ceiling effects in young participants. This study only accounted for young and old groups, and did not account for the in-between age group. 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