WO2002043592A1

WO2002043592A1 - Test for cognitive disorders

Info

Publication number: WO2002043592A1
Application number: PCT/AU2001/001542
Authority: WO
Inventors: Peter William Schofield
Original assignee: Hunter Area Health Service
Priority date: 2000-11-29
Filing date: 2001-11-28
Publication date: 2002-06-06
Also published as: AU2002223299A1

Abstract

A verbally presented test for cognitive disorders such as Alzheimer's Disease, is presented to the patient on cassette tape providing accurate time spacing between questions and allowing the test to be performed in the absence of a professional clinician. Answers to the questions are written in an answer book in such a manner that they can be marked in a few minutes and presented to the clinician for interpretation. Significant professional time is saved, enabling the test to be economically used for a wider range of patients.

Description

"TEST FOR COGNITIVE DISORDERS"

FIELD OF THE INVENTION

This invention relates to a testing method for cognitive disorders and has been devised particularly though not solely for use in screening geriatric patients for significant cognitive impairment. BACKGROUND ART h the past, many different tests have been used by clinicians to test for cognitive disorders of various types. Such tests typically comprise a series of questions posed verbally by the clinician to the patient, requiring the patient to give answers to the questions either verbally (in which case they are recorded by the clinician) or in written form, typically in an answer book or other written matrix. Typical of such tests is the Hopkins Verbal Learning Test (HVLT) which is used for testing cognitive disorders in a number of different situations, including screening geriatric patients for possible dementia. It has been found that the early detection of cognitive disorders and particularly dementing diseases such as Alzheimer's Disease (AD) can lead to treatment which is at least partially effective in counteracting the disease.

One major drawback of wide spread screening testing is that the testing is time consuming and therefore expensive, particularly when administered by a professional clinician in the manner described above. This restricts broad based screening programs. SUMMARY OF THE INVENTION

Accordingly, in one aspect, the present invention provides a method of testing a patient for cognitive disorders, comprising the steps of, providing recorded instructions and questions relating to cognitive disorder testing

on a sound recordal medium adapted to be replayed at a controlled time rate,

providing a patient with the sound recordal medium and an answer book adapted

for the written recordal of answers to questions,

and marking the answers written in the answer book by the patient, against

predetermined criteria.

Preferably, the sound recordal medium comprises a cassette tape.

Alternatively, the sound recordal medium comprises a compact disc.

Preferably, the instructions include an instruction to not stop the cassette tape or

compact disc at any time after commencement of writing answers in the answer book.

Preferably, the questions are posed, and the answer book is arranged, such that the

answers can be marked in a substantially shorter time than that taken to play the test on

the tape

Preferably, the answer book is so designed as to actively discourage the patient

from looking back at answers written in response to previously presented elements of the

test.

h a further aspect the invention provides a sound recordal medium on which is

recorded instructions and questions relating to a cognitive disorder screening test, the

instructions and questions being spread apart in replay time on the medium so as to give

predetermined time delays between selected instructions and questions. Preferably the medium comprises a cassette tape.

Alternatively the medium comprises a compact disc. BEST MODE

Notwithstanding any other forms that may fall within its scope, one preferred form of the invention will now be described, by way of example only, with reference to the annexed transcript of a typical recording on a cassette tape to be used in a testing method according to the invention. hi the preferred form of the invention, the instructions and questions relating to the cognitive disorder test are recorded on a cassette tape as it is an inexpensive medium readily available to most members of the public and able to be replayed on low cost cassette players. It will be appreciated however that the test can be recorded on any other suitable sound recordal medium, such as a compact disc (CD) playable on a compact disc player, or on a computer disk drive, or on a floppy disk playable on a computer, or any other equivalent medium. The important characteristic of the sound recordal medium is that it is able to be replayed at a controlled time rate so that questions posed in the test are presented to the patient at controlled time gap spacings and controlled times allowed for the writing of answers in the answer book.

The tape test typically includes components of several pre-existing cognitive test instruments, modified for presentation on the tape. The patient responds in writing to the questions presented on the tape and in the accompanying written material. In the preferred form of the invention where the test is used for screening geriatric patients for possible significant cognitive impairment or dementia, the most important of these components is the Hopkins Verbal Learning Test (HVLT). The HVLT is a brief verbal learning and memory test with 6 alternative forms. It consists of a 12 item word list that is read to the patient on three successive learning trials. After each trial, the patient is requested to repeat as many of the words as he can remember. A delayed recall trial is conducted after a 20 to 25 minute delay, followed by a recognition trial in which the patient has read a 24 item list which includes all of the 12 words on the original list, in addition to 12 distractors. Subjects are requested to indicate after each word whether it was on the original list. The twelve item list comprises 4 words from three semantic categories, and 6 alternative forms exist which have been demonstrated to be equivalent with respect to

the recall trials.

The HVLT has several advantages over many other memory tests. It is well tolerated by even moderately demented patients, it lacks a ceiling effect in recall in neurologically normal subjects, and the existence of comparable forms permits follow up administration without raising concern about learning effects.

Normative data for the HVLT are well published showing that performance on the HVLT correlates highly with performance on the California Verbal Learning Test. The HVLT has been shown to discriminate well between normals and patients with isolated amnesia or with mild to moderate dementia due to AD. As a consequence of these favourable characteristics, it has been recommended and used as a tool for screening for memory impairment and for tracking cognitive change.

A major disadvantage of the HVLT test is that, when administered conventionally according to prior art techniques, the test requires 25 minutes, which severely limits its utility in a general practice setting.

By recording the test on a cassette tape, and making numerous copies for distribution to clinicians, the professional time involved in running the test is significantly reduced, and furthermore, the results of the test can be "marked" by a relatively unskilled assistant by comparing the written answers against a model matrix or by using overlay screens etc.

The HVLT, presented to the patient via tape recorder, constitutes the principal episodic memory task in the preferred form of cognitive disorder test. The modified HVLT requires the patient to write down, after each of three presentations of the 12 item word list, as many of the words as he can remember. Twenty five minutes after the first presentation of the word list, the subject is requested once again to write down as many of the twelve words as possible. Immediately following this delayed recall, the subject is required to respond to a list of 24 words presented on the tape, indicating for each word whether it was on the original 12 item list by circling either the word "yes" or the word "no" on the response booklet.

The transcript of one preferred form of self-administered cognitive screen test (SACS-3) is annexed hereto as part of this specification. Other elements in the tape test include: 1. Patients are asked to write down the word "table" as many times as they can in 30 seconds. This will provide an index of the patient's speed of writing, pertinent to the patient's production of written words in the timed tests 2 and 3 below.

2. A written form of the controlled oral word association test (CO WAT) using either the letters PRW or CFL. For example, subjects are asked to write down as many words as they can in one minute beginning with the letter P, then R, then W. Subjects are asked to obey the rules of the conventionally administered COW AT.

3. Subjects are asked to write down as many exemplars of two semantic categories as they can, allowing one minute for each category. For example, fruits and colours or animals and vegetables. 4. Subjects are asked to reproduce a line drawing of a cube presented to them in the answer book.

5. Subjects are requested to identify, in writing, ten items which are pictured in the answer book. The literature suggests that a learning effect is minimal in a test - retest situation of similar time frame, therefore the same ten items can be used in different versions of the response booklet used at different times.

The answer book is laid out with various blank or lined pages for insertion of the patients answers, as well as diagrams of various articles for shape recognition and recall. The tape includes instructions to move from page to page at predetermined stages in the test and the book is designed to make it difficult for a patient to "go back" and check previously written answers. This active discouragement can be done e.g. by spacing similar answers several pages apart and/or by ensuring that the page turning pace determined by the verbal instructions ensures that the open page is always well spaced from previously entered similar material. hi this manner it is possible to provide a test for patients who may be suffering from cognitive disorders which is inexpensive to reproduce and conduct. As the test is normally self-administered by the patient, either in a doctor's office or even in their home environment, there is no professional time involved in administering the test, and furthermore the answers to the test are presented in such a form that it is easy and quick to mark e.g. in two to three minutes per test. The results can then be presented to the clinician for interpretation.

A test which previously involved thirty minutes of professional time can therefore be reduced to two to three minutes overview with a resulting significant decrease in cost. This will allow the test to be used on a far more wide ranging basis and to be financially viable for broad based screening such as screening of geriatric patients for possible dementia. Due to the low cost, the test is also a viable medium for tracking cognitive changes due to medication or environmental interventions.

ANNEXURE

Transcript of Self- Administered Cognitive Screen Test (SACS-3)

Transcript for Self-administered Cognitive Screen Study (SACS-3).

MASTER

You are about to participate in a tape recorded assessment of memory and concentration. Please adjust the volume so that you can easily hear what is being said, and ensure that you are seated comfortably and ready to give your full attention to this task. Shortly you will be presented with some questions designed to assess your memory and concentration and I would like you to respond to those questions by writing your answers in the blue booklet labelled "Assessment of Memory and Concentration". If you do not have the blue booklet and a pen with which to write your answers please stop the tape now and restart it when you have these items in front of you.

[10 seconds] It is very important that you do not stop the tape at any time from this point on.

Now l would like to explain how this assessment will be conducted. As I have already said, you should write your responses to the questions that follow in the blue booklet labelled "Assessment of Memory and Concentration". Each page of the booklet is clearly numbered at the top right hand corner. You should now have the response booklet closed, that is, with the front cover, which is page one, showing. Very soon we will begin the assessment of concentration and memory, however, there are several rules that I want to emphasise before we start.

• First, it is very important that you do NOT write anything until you are requested to do so.

• Second, it is important that you do NOT look at any pages of the response booklet before you are instructed to do so.

• Third, it is important that you do NOT turn back to check on answers completed on previous pages. That is, once you have written on a page and turned that page over you must not look back at it.

It is important that you follow these few simple rules so that your performance on this task will give a fair indication of your concentration and memory abilities.

Now I would like to begin the assessment.

[HVLT TRIAL 1]

I would like you to listen carefully to a list of words. Do not write them down as I say them. Concentrate and try to remember these words because when I have finished saying this list I want you to turn the page over and write down as many of the words as you can remember. The order is not important, neither is the spelling, just write down as many words from the list as you can. Please write neatly and clearly.

Remember it is important that you do not write anything as I say these words. Listen carefully; here are the words. SUGAR TRUMPET VIOLIN COAL GARLIC KEROSENE VANILLA WOOD CLARINET FLUTE CINNAMON GASOLINE Please turn to page two NOW and write down as many of those words as you can remember.

[50 seconds] [HVLT TRIAL 2]

If you have not finished writing please stop NOW and turn to page three [2 seconds] Page three; it is blank. I am going to say the same list of words again. Please do not write as I say the words. When I have finished saying the list I want you to turn the page and write down as many of the words as you can remember including those you wrote down on the previous page. Remember you should NOT look back through the booklet at pages you have already completed. Listen carefully; here are the words. SUGAR

TRUMPET

VIOLIN

COAL

GARLIC KEROSENE

VANILLA

WOOD

CLARINET

FLUTE CINNAMON

GASOLINE

Please turn to page four now and write down as many of those words as you can remember.

[50 seconds] [HVLT TRIAL 3] If you have not finished writing please stop NOW and turn to page five [2 seconds] Page five; it is blank. I am going to say the same list of words again. Please do not write as I say the words. When I have finished saying the list I want you to turn the page and write down as many of the words as you can remember including those you wrote down on the previous pages. Remember you should NOT look back through the booklet at pages you have already completed. Listen carefully; here are the words.

SUGAR TRUMPET

VIOLIN

COAL

GARLIC

KEROSENE VANILLA

WOOD

CLARINET

FLUTE

CINNAMON GASOLINE

Please turn to page six NOW and write down as many of those words as you can remember.

[50 seconds]

If you have not finished writing please stop NOW and turn to page seven [2 seconds] Page seven; it is blank. I want to warn you that you may be asked to recall that word list at a later time.

Please turn to page eight. [2 seconds] You should now be on page eight.

On the top half of page eight there is a line drawing or figure. When I tell you to I would like you to draw a copy of the figure in the space below it. Take care to make your copy of the figure as accurate a copy of the one shown as you can. Start NOW.

[60 seconds]

If you have not finished drawing please stop NOW and turn to page nine [2 seconds]. You should now be on page nine. It is important that you do NOT turn back to check on answers completed on previous pages. That is, once you have written on a page and turned that page over you must not look back at it.

When I tell you to I would like you to write down the word "TABLE" as many times as you can in the time available. That is, I would like you to simply write down the word "TABLE" as fast as you can, over and over, down the page until I tell you to stop. Please write clearly and neatly. Start NOW. [30 seconds]

Please stop writing NOW and turn to page ten. [2 seconds] You should now be on page ten.

When I tell you to I would like you to write down as many different types of animal as you can think of. You will have one minute to write as many types of animal as you can as quickly as you can, but please write clearly and neatly. Start NOW.

[60 seconds]

Please stop writing NOW and turn to page eleven. [2 seconds] You should now be on page eleven.

This time I would like you to write down as many different types of vegetable as you can think of. Again you will have one minute to write as many types of vegetable as quickly as you can, but please write clearly and neatly. Start NOW. [60 seconds]

Please stop writing NOW and turn to page twelve. [2 seconds] You should now be on page twelve. I am going to say a letter of the alphabet and I would like you to write down as many words that begin with that letter as quickly as you can. Before we begin I will explain some rules which I would like you to follow.

• First, you must not use proper nouns, in other words, the names of people, places or brands. So, if I gave you the letter "T" words such as Thomas, Tiffany, Texas, or Toyota would not be allowed.

• Second, you must not repeat words or use the same but with a different ending. So if you had already written down "tries", you could not then use words like "trying" or "tried".

Third, no numbers. So if the letter were "T" you could not write the number "Ten" or "Twelve".

Anything else is fine. You will have one minute to write as many words as you can as quickly as you can, but please write clearly and neatly. Remember the rules are no names of people or places, no repeats or words that are basically the same as ones already used, and no numbers. The first letter is "P", so I would like you to write down as many words beginning with the letter P as you can. Start NOW.

[60 seconds]

Please stop writing NOW and turn to page thirteen. [2 seconds] You should now be on page thirteen. Now you are going to do the same task but with a different letter. Remember the rules are no names of people or places, no repeats or words that are basically the same as ones already given, and no numbers. This time, the letter is "R" so I would like you to write down as many words beginning with the letter R as you can. Start NOW.

[60 seconds]

Please stop writing NOW and turn to page fourteen. [2 seconds] You should now be on page fourteen.

Again I would like you to do the same task but with a new letter. Remember the rules are no names of people or places, no repeats or words that are basically the same as ones already used, and no numbers.

The new letter is "W" so I would like you to write down as many words beginning with the letter W as you can. Start NOW.

[60 seconds]

If you have not finished writing please stop now and turn to page fifteen. [2 seconds] You should now be on page fifteen.

Beside each picture on this page please write the name of the object shown. If you can not name the object please place a cross beside it. Start NOW.

[30 seconds]

If you have not finished writing please stop now and turn to page sixteen. [2 seconds] You should now be on page sixteen.

Again, beside each picture on this page please write the name of the object shown. If you can not name the object please place a cross beside it. Start NOW.

[20 seconds]

If you have not finished writing please stop now and turn to page seventeen. [2 seconds] You should now be on page seventeen.

[20 seconds]

If you have not finished writing please stop now and turn to page eighteen. [2 seconds] You should now be on page eighteen.

Again, beside each picture on this page please write the name of the object shown. If you can not name the object please place a cross beside it. Start NOW. [30 seconds]

Please turn to page nineteen. [2 seconds] You should now be on page nineteen.

At the beginning of this tape I read out a list of words. I read it out three times and asked you to remember as many words as you could. Now I would like you to write down as many words as you can remember from that list. Once again please write clearly and neatly. Start NOW.

[50 seconds]

If you have not finished writing please stop NOW and turn to page twenty [2 seconds] Page twenty; it is blank.

Please turn to page twenty one. [2 seconds] You should now be on page twenty one. Now I am going to read a new list of words. Your task, for each word, will be to decide whether or not it was part of the list you were asked to remember earlier. If you believe it was on the list please place a circle around the word "yes", otherwise place a circle around the "no". If you are unsure please make your best guess, as either the "yes" or "no" must be circled for each word. The first word is Pepper. If you believe Pepper was on the list of words you were asked to remember circle "yes" beside the number one, otherwise circle no .

The second word is Garlic. If you believe Garlic was on the list of words you were asked to remember circle "yes" beside the number two, otherwise circle "no".

3 Was Wood on the list-- "yes" or "no".

4 Was Drum on the list-- "yes" or "no".

5 Was Oil on the list- "yes" or "no".

6 Was Sugar on the list-- "yes" or "no". 7 Was Ball on the list - "yes" or "no".

8 Was Salt on the list-- "yes" or "no".

9 Was Priest on the list-- "yes" or "no".

10 Was Chair on the list- "yes" or "no".

11 Was coal on the list- "yes" or "no". 12 Was Clarinet on the list- "yes" or "no".

13 Was Trumpet on the list - "yes" or "no".

14 Was Basement on the list- "yes" or "no".

15 Was Cinnamon on the list- "yes" or "no".

16 Was Flute on the list- "yes or "no". 17 Was Electricity on the list - "yes or "no".

18 Was Moon on the list- "yes" or "no".

19 Was Kerosene on the list- "yes" or "no".

20 Was Vanilla on the list- "yes" or "no". 21 Was Gasoline on the list- "yes" or "no".

22 Was Sand on the list- "yes" or "no".

23 Was Piano on the list- "yes" or "no".

24 Was Violin on the list- "yes" or "no".

Please turn to page twenty two.

Thankyou.

That completes the assessment.

Would you now please fill out the questionnaire accompanying this booklet. Please place the blue booklet and completed questionnaire in the envelope provided.

Claims

CLATMS:-

1. A method of testing a patient for cognitive disorders comprising the steps of:

providing recorded instructions and questions relating to cognitive disorder testing

on a sound recordal medium adapted to be replayed at a controlled time rate,

providing the patient with the sound recordal medium and an answer book adapted

for the written recordal of answers to questions,

and marking the answers written in the answer book by the patient against

predetermined criteria.

2. A method of testing a patient for cognitive disorders as claimed in claim 1 wherein

the sound recordal medium comprises a cassette tape.

3. A method of testing a patient for cognitive disorders as claimed in claim 1 wherein

the sound recordal medium comprises a compact disc.

4. A method of testing a patient for cognitive disorders as claimed in any one of the

preceding claims wherein the questions are posed, and the answer book is arranged, such

that the answers can be marked in a substantially shorter time than is taken to play the

test on the sound recordal medium.

5. A method of testing a patient for cognitive disorders as claimed in any one of the

preceding claims wherein the answer book is configured and used in combination with

instructions on the sound recordal medium in such a manner as to actively discourage the

patient from looking back at answers written in response to previously presented elements of the test.

6. A sound recordal medium on which is recorded instructions and questions relating to a cognitive disorder screening test, the instructions and questions being spread apart in replay time on the medium so as to give predetermined time delays between selected instructions and questions.

7. A sound recordal medium as claimed in claim 6 wherein the medium comprises a cassette tape.

8. A sound recordal medium as claimed in claim 6 wherein the medium comprises a compact disc.