The CANS-MCI Test Battery: 8 Tests in 3 Cognitive Domains

 

THREE COGNITIVE DOMAINS

Memory and complex cognitive (“executive”) functions using various symbol fluency and information-processing tasks (simple and complex) are predictive of dementia.

 

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MEMORY

The most predictive methods of memory measurement (category-guided memory acquisition, immediate and delayed free and guided recall) were selected and combined to create the most reliable and longitudinally valid composite Memory factor score.

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LANGUAGE/SYMBOL FLUENCY

Impairments in multiple cognitive domains are predictive of MCI-to-AD progression — even among patients diagnosed with single-domain, amnestic MCI. Word and symbol fluency are associated with a greater risk of progression to AD dementia than are memory deficits alone.

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PROCESSING SPEED/EXECUTIVE FUNCTIONS

Attentional speed along with several dimensions of attention flexibility add to the robust predictive capacity and reliability of the Executive Function factor score.

 

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8 SELF-ADMINISTERED TESTS

The assessment of cognition includes measures of free and guided recall, delayed free and guided recognition, primed picture naming, word-to-picture matching, design matching, clock hand placement and the Stroop Test

 

ORIENTATION

Presents progressively more difficult tests of general reaction time. (Contributes to the executive function factor score.)

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WORD-TO-PICTURE MATCHING

Presents sets of four pictures with a word that describes one of the four. The patient is instructed to touch the picture that goes with the word. (Contributes to the symbol fluency factor score.)

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FREE AND GUIDED RECALL – IMMEDIATE

The patient learns 5 sets of four different pictures by touching ones that fit into categories. The same items are displayed for free recall, shown along with two incorrect items from other categories. Incorrect answers are tested for category-guided recall and items are re-learned before a new free recall trial. (Contributes to the memory factor score.)

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DESIGN MATCHING

Presents 8 designs, paired with letters in non-alphabetical order, and a set of buttons with the letters in alphabetical order. One of the designs is presented and the patient is instructed to touch its paired letter. Complexity of the required attention-switching is increased by design similarity.  (Contributes to the executive factor score.)

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CLOCK HAND PLACEMENT

Ten blank clock faces are presented with a digital time. The patient is instructed to touch the appropriate hour-hand position and then the appropriate minute-hand position on an analog clock face. (Contributes to the symbol fluency factor score.)

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STROOP

The patient is instructed to touch buttons matching the ink color, not the word name, of the words “red”, “blue”, or “green”, which are shown one at a time in either red, blue or green ink. (Contributes to the executive function factor score.)

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NAMING

Pictures in multiple categories are shown, each with one correct, and three incorrect, 2-letter ‘word beginnings’ (e.g., Ro….. for a picture of a Rose). The patient is instructed to touch the most likely word beginning. (Recognition latency scores contribute to the executive function factor score.)

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FREE AND GUIDED RECALL – DELAYED

Presents a delayed trial of the Free And Guided Recall tests. (Contributes to the memory factor score.)

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TEST MEASUREMENT

To determine how close the patient’s cognitive abilities are to a sub-group with similar educational backgrounds, the patient’s abilities are measured in eight ways. These results are then compared against the distribution of test results for others having similar education.

In addition, if they have previously taken Screen’s tests, the patient’s past test results are compared to the latest results and plotted over time (longitudinally) so that the earliest important cognitive changes can be detected in each of the three cognitive domains. By using longitudinal analyses with scalable test scores — even if the patient’s current test results are within the “normal” range — cognitive declines within that range can be detected, providing early warnings of active decline even in highly functioning patients.

Taking into account test scores, longitudinal patterns, and other background information (e.g., age, education, depression, pain medication, solvent exposure, alcohol use, head injuries, and exercise), Screen develops an overall probability that if the patient were tested by the “gold standard” of a full neuropsychological evaluation, it would confirm the presence or absence of MCI. (Note: the “gold standard” referenced here is the full battery of neuropsychological tests that Screen measured itself against in a major study: it was administered by a completely independent neuropsychologist, took hours of face-to-face time, and cost approximately $2,000 per subject).

STATISTICAL VALIDATION OF THE CANS-MCI

Screen’s test battery, the CANS-MCI, has been shown to be a scientifically valid screening tool. The eight cognitive testing tasks used in its test battery have proven to represent strong, independent predictors of subsequent dementia of the Alzheimer’s type(1). As reported in the Journal of Neuropsychiatry and Clinical Neurosciences, (2005), Screen’s test battery was validated through an extensive research study covering over 400 people from all economic, educational and age backgrounds in Western Washington. This study showed that the CANS-MCI was highly reliable and a valid measurement technique when compared to conclusions reached with the more laborious, in-person standard measures used by neuropsychologists to detect MCI.
Also, in a separate study(2), Screen explicitly evaluated its test battery against an actual, independent, full neuropsychological exam (the “gold standard” costing $2,000 per patient report) to see if the CANS-MCI could accurately predict the people who, when given the full neuropsychological exam, would be classified as having MCI. Although Screen’s test battery only cost a small fraction of the amount for a full, in-person battery, it predicted nearly identically which people would be classified by the gold standard as having MCI or as normal-functioning.

Screen’s Test Battery vs. Gold Standard for 2 Education Sub-groups: ROC Analysis

Education Area Under Curve % Sensitivity % Specificity
Less Than 13 Years 1.0 100 100
13 or More Years .96 100 84.8

The CANS-MCI has been consistently referenced by major journals in articles that covered computer-directed neuropsychological tests. In 2008, in a study that systematically reviewed the top 11 computer-based test batteries that are used to detect cognitive decline in aging populations, independent researchers gave Screen’s CANS-MCI test battery the top overall score in all categories that were assessed.

Jane B. Tornatore, PhD Emory Hill, PhD Jo Anne Laboff, MSW, “Self-Administered Screening for Mild Cognitive Impairment: Initial Validation of a Computerized Test Battery,” Journal of Neuropsychiatry and Clinical Neurosciences, Volume 17, No. 1, 98-105, Winter, 2005.

Jane B. Tornatore, PhD, Emory Hill, PhD, Jo Anne Laboff, MSW The CANS-MCI: Self-administered Screening for Mild Cognitive Impairment. Alzheimer’s and Dementia, 1, Suppl 1, 104, 2005. (Abstract)

Stelios Zygouris & Magdalini Tsolaki Current State of Self-Administered Brief Computerized Cognitive Assessments for Detection of Cognitive Disorders in Older Adults: A Systematic Review. American Journal Alzheimers Disease and Other Dementias, 2015;30(1):13-28.

Wild K, Howieson D, Webbe F, Seelye A, Kaye J. Status of computerized cognitive testing in aging: a systematic review. Alzheimers Dementia. 2008; 4(6):428–437. Each test battery was rated on the availability of normative data, level of evidence for test validity & reliability, comprehensiveness and usability.