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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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Abstract  

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.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2019.0115     OR     http://www.aginganddisease.org/EN/Y2019/V10/I6/1258
Figure 1.  Instruction page of Five-minute Cognitive test.
Figure 2.  Picture page of Five-minute Cognitive test.
Figure 3.  The FCT test.

Characteristics
CN
(n =107)
MCI
(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.
FCTEquivalent
MMSE
FCTEquivalent
MMSE
FCTEquivalent
MMSE
FCTEquivalent
MMSE
0105.518112316.527
0.51061911.5241727
1116.520122417.528
1.51272112.5241828
2127.521132418.529
2.51382213.5251929
3148.522142519.530
3.51592214.5252030
4169.5231526
4.517102315.526
51710.5231626
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.
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