Simple test may predict cognitive impairment before symptoms appear

• Researchers say a simple memory test involving cards can help predict cognitive impairment years before symptoms arise.
• Experts say the test would allow for earlier treatment and preventive measures for people at higher risk of developing dementia.
• One expert suggests the test be given to all people over the age of 45.

Researchers say they’ve developed a simple test that can predict the future risk of a person developing cognitive impairment.

In their study published today in the journal Neurology, the scientists say the test only applies to people with no existing cognitive and memory issues.

“There is increasing evidence that some people with no thinking and memory problems may actually have very subtle signs of early cognitive impairment,” said Ellen Grober, Ph.D., a study author and clinical professor at the Albert Einstein College of Medicine in New York City, in a statement. “In our study, a sensitive and simple memory test predicted the risk of developing cognitive impairment in people who were otherwise considered to have normal cognition.”

Details on the cognitive impairment study

The study’s 969 subjects, who had an average age of 69, were given a simple memory test with follow ups over the next 10 years.

The test included two phases.

First, the researchers asked the participants to look at four cards, with each card having drawings of four items.

The subjects were then asked to identify each item belonging to a particular category. For example, participants were asked to identify a fruit, for which they would answer “grape.”

In the next phase, participants were asked to recall the items to measure their ability to retrieve information. For items they didn’t remember, they were given category cues, which measured memory storage.

Results from the cognitive impairment tests

Researchers divided the participants into five groups with stages zero through four, based on their test scores, as part of the Stages of Objective Memory Impairment (SOMI) system.

Stage zero (47% of subjects) was for those with no memory problems.

Stages one (35%) and two (13%) reflected increasing difficulty with retrieving memories, which researchers said can precede dementia by 5 to 8 years. These participants could remember items when given cues.

The third and fourth stages (a combined 5%) represented subjects who couldn’t remember all the items even with cues. The scientists said these stages precede dementia by 1 to 3 years.

Of the 969 participants, 234 eventually developed cognitive impairment.

After adjusting for age, gender, education and a gene affecting a person’s risk of Alzheimer’s disease called APOE4, subjects at stages one and two were twice as likely to develop cognitive impairment when compared to people at SOMI stage zero.

Subjects at stages three and four were three times as likely to develop cognitive impairment.

The importance of cognitive impairment testing

After adjusting for biomarkers of Alzheimer’s disease, such as amyloid plaques and tau protein tangles, the SOMI system continued to predict an increased risk of cognitive impairment.

Researchers estimated that after a decade, about 72% of those in the third and fourth stages would have developed cognitive impairment, compared to about 57% of those in the second stage, 35% in the first stage, and 21% of those in stage zero.

“Our results support the use of the SOMI system to identify people most likely to develop cognitive impairment,” Grober said. “Detecting cognitive impairment at its earliest stages is beneficial to researchers investigating treatments. It also could benefit those people who are found to be at increased risk by consulting with their physician and implementing interventions to promote healthy brain aging.”

Dr. Thomas Burke, a neurologist and medical director of virtual headache and migraine clinic Neura Health, noted that current tests only look at the current state of the brain.

“Predicting neurological change years later is very difficult,” Burke told Medical News Today. “When a person undergoes neurological testing, we are getting a snapshot of their current brain function, not what their brain will look like years later.”

“This does give some evidence for being able to determine the risks of developing memory issues moving forward,” he added.

Dr. Dale Bredesen, the director of the University of California Los Angeles’ Easton Center for Alzheimer’s Disease Research, told Medical News Today there’s definitely a need for “a simple and fairly rapid test,” especially since it’s becoming clear that early treatment can make a difference.

“Standard neurocognitive tests can take hours and are therefore impractical for screening, and the typical brief tests such as MMSE are not sensitive enough to detect these early changes,” Bredesen said. “This is a welcome report that can help practitioners to identify those at high risk for the development of cognitive decline.”

Making use of new memory tests

Bredesen said current tests are used on people who already have cognitive issues.

“Simple tests like the one described in this report should be included for everyone over the age of 45, to identify those who should be evaluated further, and potentially treated,” he said

One doctor told Medical News Today that the SOMI system reminded him of a familiar children’s game.

“I advise my patients when they have to recall the three words to make a mental image of a scene with all three words to help in their recall,” said Dr. Clifford Segil, a neurologist at Providence Saint John’s Health Center in California. “For this proposed card cognitive test, I would advise the same. Current cognitive tests involve other memory domains.”

“As I have kids and am a practicing adult neurologist, I find it interesting that this proposed test to be used in my elderly population is similar to ‘Go Fish,’ which is used as a learning tool in kids rather than a cognitive assessment in old people,” Segil said.

“When you start being concerned you are having memory loss you should be evaluated by a neurologist to determine if your complaints are within the broad range of age appropriate normal or something else,” he said.

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