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Aging and disease    2019, Vol. 10 Issue (6) : 1258-1269     DOI: 10.14336/AD.2019.0115
Orginal Article |
Five-Minute Cognitive Test as A New Quick Screening of Cognitive Impairment in The Elderly
Jie Zhangsup>1, Lijun Wangsup>1, Xia Dengsup>1, Guoqiang Feisup>1, Lirong Jinsup>1, Xiaoli Pansup>1, Liuhan Cai2, Anthony D Albano3, Chunjiu Zhong1,*
1Department of Neurology, Zhongshan Hospital; State Key Laboratory of Medical Neurobiology; Institute of Brain Science; Fudan University, Shanghai, China.
2Department of Psychometrics, Research, and Data, Measured Progress, Dover, NH 03820, USA
3Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
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This study aims to develop a new evaluation method for quickly and conveniently screening cognitive impairment in the elderly. The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Subsequently, FCT efficiencies in differentiating normally cognitive ability from cognitive impairment were explored and compared with that of the Mini-Mental Status Evaluation (MMSE). Equipercentile equating method was utilized to create a crosswalk between scores of the FCT and MMSE. Further, the association of scores of the FCT and MMSE with hippocampal volumes was investigated. There were 241 subjects aged 60 years or above enrolled in this study, including 107 adults with cognitive abilities in normal range, 107 patients with mild cognitive impairment (MCI), and 27 patients with mild Alzheimer disease (AD). The AUC of FCT for detection of cognitive impairment (MCI and mild AD) was 0.885 (95% CI 0.838 to 0.922). The sensitivity and specificity of FCT for the diagnosis of cognitive impairment were 80.6% and 84.11 %, respectively. FCT’s diagnostic performance was superior to that of MMSE in the same cohort. Mean completion time of FCT was 339.9 ± 67.7 seconds (5-6 min). In addition, a conversion table between scores on the FCT and MMSE was created. Further, the FCT scores were positively correlated with hippocampal volumes. The FCT is a novel, reliable, and valid cognitive screening test for the detection of dementia at early stages.

Keywords mild cognitive impairment      Alzheimer’s disease      brief cognitive test      equipercentile equating method     
Corresponding Authors: Zhong Chunjiu   
About author: These authors make contributions equally to this work.
Just Accepted Date: 02 March 2019   Issue Date: 16 November 2019
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Zhang Jie
Wang Lijun
Deng Xia
Fei Guoqiang
Jin Lirong
Pan Xiaoli
Cai Liuhan
Albano Anthony D
Zhong Chunjiu
Cite this article:   
Zhang Jie,Wang Lijun,Deng Xia, et al. Five-Minute Cognitive Test as A New Quick Screening of Cognitive Impairment in The Elderly[J]. Aging and disease, 2019, 10(6): 1258-1269.
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Figure 1.  Instruction page of Five-minute Cognitive test.
Figure 2.  Picture page of Five-minute Cognitive test.
Figure 3.  The FCT test.

(n =107)
(n = 107)
Mild AD
(n = 27)
P value
Age, years69.6 ± 5.469.7 ± 5.772 ± 7.90.149
Male/Female, n40/6739/6810/170.99
Education, years11.7 ± 2.811.4 ± 2.99.9 ± 4.14 $0.02
CDR0 ± 0.050.36 ± 0.22 #0.96 ± 0.1 $, &<0.001
ADL20.2 ± 0.420.8 ± 0.8 #24.6 ± 2.9 $, &<0.001
MMSE27.9 ± 1.2826.3 ± 1.9 #20.1 ± 2.9 $, &<0.001
FCT17.8 ± 1.214.9 ± 2.8 #8 ± 3.2 $, &<0.001
AVLT- delayed recall5.94 ± 2.052.91 ± 2.08/<0.001
Animal fluency16.7 ± 3.6313.9 ± 3.71/<0.001
BNT-3024.2 ± 3.2821.7 ± 3.76/<0.001
TMT-A56.1 ± 13.172.2 ± 25.4/<0.001
TMT-B153 ± 44201 ± 59.3/<0.001
CFT30.3 ± 2.9226.4 ± 4.72/<0.001
SDMT37.9 ± 7.6230.9 ± 9.33/<0.001
Table 1  Demographics and clinical characteristics according to diagnosis.
Figure 4.  FCT and MMSE scores in three diagnostic groups. Abbreviations: CN: Cognitively normal; MCI: Mild cognitive impairment; AD: Alzheimer’s disease; MMSE: Mini-mental state examination; FCT: Five-minute cognitive test.
Figure 5.  ROC analysis of FCT and MMSE. Abbreviations: CN: Cognitively normal; MCI: Mild cognitive impairment; AD: Alzheimer’s disease; CI: Cognitively impaired; MMSE: Mini-mental state examination; FCT: Five-minute cognitive test.
Table 2  Equivalent MMSE scores are shown for possible scores on the FCT.
Figure 6.  A plot of the equipercentile equivalent scores on the MMSE and FCT. Abbreviations: MMSE: Mini-mental state examination; FCT: Five-minute cognitive test.
Figure 7.  Correlations between the FCT scores and other cognitive domains. Abbreviation: FCT: Five-minute cognitive test. AVLT: Auditory Verbal Learning Test; BNT-30: Boston Naming Test-30; TMT-A: Trail Making Test A; TMT-B: Trail Making Test B; CFT: Rey-Osterrieth Complex Figure Test; SDMT: Symbol Digit Modalities Test.
Figure 8.  Correlations of FCT and MMSE scores with Hippocampal volumes in non-demented elderly. Abbreviations: MMSE: Mini-mental state examination; FCT: Five-minute cognitive test.
VariablesOverall sample (n = 62)
Age, y69.4 ± 5.6
Female gender, n (%)45 (72.6)
Education, y12 ± 2.8
FCT16.7 ± 2.5
MMSE27.3 ± 1.9
Hippocampal volume, ml7.5 ± 0.9
Table 3  Demographic and clinical information of 62 non-demented elderly.
[1] Lonie JA, Tierney KM, Ebmeier KP (2009). Screening for mild cognitive impairment: a systematic review. Int J Geriatr Psychiatry, 24:902-915.
[2] Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA (2007). A review of screening tests for cognitive impairment. J Neurol Neurosurg Psychiatry, 78:790-799.
[3] Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E (1999). Mild cognitive impairment: clinical characterization and outcome. Arch Neurol, 56:303-308.
[4] Ozer S, Young J, Champ C, Burke M (2016). A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment. Int J Geriatr Psychiatry, 31:1139-1150.
[5] Folstein MF, Folstein SE, McHugh PR (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12:189-198.
[6] Beinhoff U, Hilbert V, Bittner D, Gron G, Riepe MW (2005). Screening for cognitive impairment: a triage for outpatient care. Dement Geriatr Cogn Disord, 20:278-285.
[7] Borson S, Scanlan JM, Watanabe J, Tu SP, Lessig M (2005). Simplifying detection of cognitive impairment: comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample. J Am Geriatr Soc, 53:871-874.
[8] Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 53:695-699.
[9] Kandiah N, Zhang A, Bautista DC, Silva E, Ting SK (2016). Early detection of dementia in multilingual populations: Visual Cognitive Assessment Test (VCAT). J Neurol Neurosurg Psychiatry, 87:156-160.
[10] Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR (2006). The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry, 21:1078-1085.
[11] Brown J (2015). The use and misuse of short cognitive tests in the diagnosis of dementia. J Neurol Neurosurg Psychiatry, 86:680-685.
[12] Rakusa M, Jensterle J, Mlakar J (2018). Clock Drawing Test: A Simple Scoring System for the Accurate Screening of Cognitive Impairment in Patients with Mild Cognitive Impairment and Dementia. Dement Geriatr Cogn Disord, 45:326-334.
[13] Lindeboom J, Schmand B, Tulner L, Walstra G, Jonker C (2002). Visual association test to detect early dementia of the Alzheimer type. J Neurol Neurosurg Psychiatry, 73:126-133.
[14] Morris JC (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology.
[15] Petersen RC (2004). Mild cognitive impairment as a diagnostic entity. J Intern Med, 256:183-194.
[16] McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984). Clinical diagnosis of Alzheimer's disease Report of the NINCDS-ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34:939-939.
[17] Guo Q, Lv C, Hong Z (2001). Reliability and validity of auditory verbal learning test on Chinese elderly patients. J of Chinese Ment Health, 15:13-15.
[18] Guo Q, Chuanzhen L, Hong Z (2000). Application of Rey-Osterrieth complex figure test in Chinese normal old people. Chin J Clin Psych, 8. 205-207.
[19] Zhao Q, Guo Q, Shi W, Zhou Y, Hong Z (2007). Category verbal fluency test in identification and differential diagnosis of dementia. Chin J Clin Psych, 3:241-245.
[20] Lu J, Guo Q, Hong Z, Shi W, Lv C (2006). Trail Making Test Used by Chinese Elderly Patients with Mild Cognitive Impairment and Mild Alzheimer'Dementia. Chin J Clin Psych, 14:118.
[21] Smith A (1982). Symbol digit modalities test: Western Psychological Services Los Angeles, CA.
[22] Sheikh JI, Yesavage JA (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist: J Aging Ment Health. 5(1-2), 165-173.
[23] Coppola G, Petolicchio B, Di Renzo A, Tinelli E, Di Lorenzo C, Parisi V, et al. (2017). Cerebral gray matter volume in patients with chronic migraine: correlations with clinical features. J Headache Pain, 18:115.
[24] Besteher B, Gaser C, Langbein K, Dietzek M, Sauer H, Nenadic I (2017). Effects of subclinical depression, anxiety and somatization on brain structure in healthy subjects. J Affect Disord, 215:111-117.
[25] Roalf DR, Moberg PJ, Xie SX, Wolk DA, Moelter ST, Arnold SE (2013). Comparative accuracies of two common screening instruments for classification of Alzheimer's disease, mild cognitive impairment, and healthy aging. Alzheimers Dement, 9:529-537.
[26] Kolen MJ, Brennan RL (1995). Test equating : methods and practices. Springer, 16:193-215.
[27] van Steenoven I, Aarsland D, Hurtig H, Chen-Plotkin A, Duda JE, Rick J, et al. (2014). Conversion between mini-mental state examination, montreal cognitive assessment, and dementia rating scale-2 scores in Parkinson's disease. Mov Disord, 29:1809-1815.
[28] Roalf DR, Moore TM, Mechanic-Hamilton D, Wolk DA, Arnold SE, Weintraub DA, et al. (2017). Bridging cognitive screening tests in neurologic disorders: A crosswalk between the short Montreal Cognitive Assessment and Mini-Mental State Examination. Alzheimers Dement, 13:947-952.
[29] Fong TG, Fearing MA, Jones RN, Shi P, Marcantonio ER, Rudolph JL, et al. (2009). Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination. Alzheimers Dement, 5:492-497.
[30] Adelson JL (2013). Educational research with real-world data: Reducing selection bias with propensity scores. Practical Assessment, Research & Evaluation, 18:2.
[31] Randolph JJ, Falbe K (2014). A step-by-step guide to propensity score matching in R. Practical Assessment, Research & Evaluation, 19.
[32] Diedenhofen B, Musch J (2015). cocor: a comprehensive solution for the statistical comparison of correlations. PLoS One, 10:e0121945.
[33] Sarazin M, Berr C, De Rotrou J, Fabrigoule C, Pasquier F, Legrain S, et al. (2007). Amnestic syndrome of the medial temporal type identifies prodromal AD: a longitudinal study. Neurology, 69:1859-1867.
[34] Rabin LA, Wang C, Katz MJ, Derby CA, Buschke H, Lipton RB (2012). Predicting Alzheimer's disease: neuropsychological tests, self-reports, and informant reports of cognitive difficulties. J Am Geriatr Soc, 60:1128-1134.
[35] Kilpatrick C, Murrie V, Cook M, Andrewes D, Desmond P, Hopper J (1997). Degree of left hippocampal atrophy correlates with severity of neuropsychological deficits. Seizure, 6:213-218.
[36] Ystad MA, Lundervold AJ, Wehling E, Espeseth T, Rootwelt H, Westlye LT, et al. (2009). Hippocampal volumes are important predictors for memory function in elderly women. BMC Medi Imaging, 9:17.
[37] Eldridge LL, Knowlton BJ, Furmanski CS, Bookheimer SY, Engel SA (2000). Remembering episodes: a selective role for the hippocampus during retrieval. Nat Neurosci, 3:1149-1152.
[38] Kantarci K, Weigand SD, Przybelski SA, Preboske GM, Pankratz VS, Vemuri P, et al. (2013). MRI and MRS predictors of mild cognitive impairment in a population-based sample. Neurology, 81:126-133.
[39] Landau S, Harvey D, Madison C, Reiman E, Foster N, Aisen P, et al. (2010). Comparing predictors of conversion and decline in mild cognitive impairment. Neurology, 75:230-238.
[40] Grober E, Buschke H, Crystal H, Bang S, Dresner R (1988). Screening for dementia by memory testing. Neurology, 38:900-903.
[41] Tounsi H, Deweer B, Ergis AM, Van der Linden M, Pillon B, Michon A, et al. (1999). Sensitivity to semantic cuing: an index of episodic memory dysfunction in early Alzheimer disease. Alzheimer Dis Assoc Disord, 13:38-46.
[42] Dubois B, Albert ML (2004). Amnestic MCI or prodromal Alzheimer's disease? Lancet Neurol, 3:246-248.
[43] Siedlecki KL, Manly JJ, Brickman AM, Schupf N, Tang MX, Stern Y (2010). Do neuropsychological tests have the same meaning in Spanish speakers as they do in English speakers? Neuropsychology, 24:402-411.
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