New Tool for Detecting Dementia a Potential Alternative to MMSE

A new cognitive assessment tool with 16 items appears potentially useful for identifying problems in thinking, learning, and memory among older adults, according to a report to be published in the March 14 print issue of Archives of Internal Medicine.

The most widely known and used measure of cognitive impairment is the Mini-Mental State Examination (MMSE); however, scores on this assessment may be influenced by education level, and copyright limits its widespread availability. In response, Tamara G. Fong, MD, PhD, of Hebrew SeniorLife, and colleagues have developed a different instrument called the “Sweet 16” to rapidly assess cognitive status in older adults.

The Sweet 16 scale is scored from zero to 16 (with 16 representing the best score) and includes questions that address orientation (identification of person, place, time and situation), registration, digit spans (tests of verbal memory) and recall. “The Sweet 16 required no pencil, paper or other props and was easy to administer with a minimum of training,” the report’s authors wrote. Completion time for the instrument ranges from one to two minutes.

When administered to participants in the validation group, a Sweet 16 score of 14 or less correctly identified 80% of the individuals with cognitive impairment (as identified by another questionnaire) and correctly identified 70% of those who did not have cognitive impairment. In the same group, the MMSE correctly identified 64% of those with cognitive impairment and correctly identified 86% of those who did not have cognitive impairment.

The researchers also compared the Sweet 16 to clinicians’ diagnoses of cognitive impairment. Sweet 16 scores of 14 or less occurred in 99% of patients diagnosed with cognitive impairment and 28% of those without such a diagnosis.

To develop the instrument, researchers used information from a group of 774 patients who completed the MMSE as part of a screening process for a large randomized trial of a method to decrease delirium. They then validated their results among 709 participants in another study that also used two different dementia and cognitive decline rating scales.

“The Sweet 16 could be used in place of other screening measures, such as the MMSE, to rapidly identify cognitive impairments in general clinical practice as well as in research settings,” the authors wrote. “Further studies, including prospective studies to establish the predictive validity of the Sweet 16, to assess test-retest reliability and to compare performance with other brief cognitive measures, are greatly needed. Ultimately, it is hoped that this test will help improve assessment of cognitive function across many settings.”

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