New question-based test may help spot early signs of dementia

• Early diagnosis is important for all types of dementia.
• The methods researchers currently use for early detection or screening of dementia can be costly, not available, or come with certain risks.
• Researchers from Murdoch University have developed a screening test where people self-report their concerns in six different cognitive areas to help determine a person’s dementia risk.

Researchers estimate that more than 55 million people around the world live with dementia .

Dementia is an umbrella term for diseases affecting a person’s abilities to remember, think, and communicate. Currently, the most common type of dementia is Alzheimer’s disease .

With all types of dementia, early diagnosis is important. Although there is currently no cure for any kind of dementia, early diagnosis helps physicians tap into medications and other options available to help slow disease progression.

Over the last few years, researchers have been working on finding new ways of diagnosing dementia at its earliest stages.

One such group is from Murdoch University in Western Australia, where researchers have developed a new test where people self-report their concerns in six different cognitive areas — such as memory, concentration, and language — to help determine a person’s dementia risk.

Their findings were published in the journal Age and Ageing.

“In the era where disease-modifying treatments are on the horizon, the earlier we identify those who require intervention, the better the outcome of such dementia treatment will be,” Hamid R. Sohrabi, BSc, MSc, PhD , executive director of Health Future Institute, director of the Centre for Healthy Ageing and Professor of Psychology and Clinical Neuroscience in the School of Psychology at Murdoch University in Western Australia, and lead author of this study told Medical News Today .

“Current methods of early detection or screening those at risk of dementia are costly, not available in most places, and may have certain risks. As such, identifying those who should move to more medically robust assessments like brain imaging is critical so that we use our resources in the best way possible.”
— Hamid R. Sohrabi, BSc, MSc, PhD

Focusing on subjective cognitive decline

To develop this new screening test called the McCusker Subjective Cognitive Impairment Inventory (McSCI), Sohrabi and his team focused on measuring a person’s subjective cognitive decline .

Subjective cognitive decline is when a person self-reports worsening brain functions such as memory loss, confusion, and thinking.

Previous studies have correlated subjective cognitive decline to a higher risk for mild cognitive impairment and dementia, as well as Alzheimer’s disease progression .

“Subjective cognitive decline increases the risk of dementia by about two-fold,” Sohrabi explained.

“However, the measures available in the field were not robust enough to be used in clinical practice and with individuals. As such we work very hard to develop a measure that can be used in both research and clinical practice and with outstanding accuracy. We were very confident at the beginning (that) the McSCI (would) be a great measure but it did far better than we expected when we finalized the statistical analysis on it,” he said.

How does the McSCI screening tool for dementia work?

The McSCI screening test is a 46-item, self-reporting questionnaire that allows a person to address their concerns in six cognitive areas:

• memory
• language
• orientation
• attention and concentration
• visuoconstruction abilities
• executive function

During the study, researchers found the McSCI screening tool can identify individuals with above-average levels of subjective cognitive decline with a 99.9% accuracy.

“It is a questionnaire (that) should be completed under a clinician’s supervision as the score could be misleading for those without such education and expertise,” Sohrabi said. “The higher the score on the McSCI, the more concerned one is (about) reporting their cognitive abilities.”

“ Memory complaints are important and should be considered seriously,” he continued. “However, the McSCI does not ask only about memory. It does ask about several cognitive functions that our research and others have shown to be important. In addition, it does provide (a) cut of scores for general practitioners and clinicians that can help to decide whether they should do any further assessments on their patients.”

Additionally, researchers developed the McSCI to be open access, allowing it to be used by doctors and researchers at no cost.

“We are working on an informant version of this measure and also on online apps that can further facilitate the use of the McSCI, if we get further funding available to us,” Sohrabi added.

Breaking through the brain health bottleneck

After reviewing this study, Karen D. Sullivan, PhD, ABPP , a board-certified neuropsychologist, owner of I CARE FOR YOUR BRAIN, and Reid Healthcare Transformation Fellow at FirstHealth of the Carolinas in Pinehurst, NC, told MNT that we have a massive bottleneck in the worldwide healthcare system with not enough brain health specialists and the largest aging population in world history at risk for the neurodegenerative diseases who need early and accurate dementia diagnoses to benefit from current treatments.

“We need innovative solutions to this public health crisis,” Sullivan continued. “Standardized, sensitive, and predictive self-reports like the McSCI are an important element of a screening procedure, but we also need to integrate them with reports from someone who knows the person well and can share their observations of any cognitive, behavioral, and functional change and cognitive assessments to rate brain function in action.”

“I’d like to see how the McSci correlates with future diagnosis of the different dementia subtypes . I predict it may be inversely related to Alzheimer’s disease specifically. In my clinical experience as a neuropsychologist, the less subjective complaints about cognitive decline, the more likely it is Alzheimer’s.”
— Karen D. Sullivan, PhD, ABPP

Further research required

MNT also spoke with Jasdeep S. Hundal, PsyD, ABPP-CN , director of The Center for Memory & Healthy Aging at Hackensack Meridian Jersey Shore University Medical Center and associate professor of psychiatry and neurology at Hackensack Meridian Health School of Medicine in New Jersey, about this study.

Hundal commented his initial reaction to this study was one of cautious enthusiasm.

“The introduction of a well-validated self-report measure like the McSCI-S could be a useful tool in early detection and treatment,” he explained. “I also appreciate the study’s comprehensive approach in developing and validating the McSCI-S. Its excellent internal consistency and significant associations with established objective cognitive measures underscore its potential utility in both clinical and research settings.”

“This enthusiasm is tempered with caution,” Hundal continued. “First, the reliance on self-reported data, while valuable, can be susceptible to various biases. Factors such as suboptimal awareness of deficits, mood disorders, personality traits, and the inherent subjectivity of self-assessment can impact the accuracy of the McSCI-S. Moreover, the cut-off score of ≥24, although chosen for its high sensitivity, has relatively low specificity, raising concerns about false positives. These issues may impact the integration of the McSCI-S into clinical practice.”

Hundal suggested next research steps include validation studies with more diverse populations and across different geographical areas, as well as longitudinal studies to track patients over a longer time frame.

“Another important step could be correlating the McSCI-S results with additional objective measures, like Alzheimer’s disease biomarkers ,” he added.

“Integrating subjective assessments with objective biological markers could enhance diagnostic accuracy and provide a more comprehensive understanding of the cognitive changes associated with Alzheimer’s.”
— Jasdeep S. Hundal, PsyD, ABPP-CN