THREE COGNITIVE DOMAINS
Memory and complex cognitive (“executive”) functions using various symbol fluency and information-processing tasks (simple and complex) are predictive of dementia.
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.
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.
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.
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.)
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.)
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.)
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.)
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.)
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.)
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.)
FREE AND GUIDED RECALL – DELAYED
Presents a delayed trial of the Free And Guided Recall tests. (Contributes to the memory factor score.)
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.
| 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.