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Budson & Price 4 Web Supplement

second is the Information-Memory-Concentration test which is administered to the

patient.

Episodic memory is evaluated on the Information-Memory-Concentration test by

the 5-Minute Recall section and most questions on the Information section. By

contrast, the Personal Memory and Non-personal Memory sections sample remotely

learned information which is part of semantic memory.

Note that the number of impaired responses (or errors) are commonly reported for

the BDS, rather than the number of unimpaired (or correct) responses. Thus, the most

severely demented patient would score 28 on the caregiver scale and 37 on the

Information-Memory-Concentration test. For the caregiver scale, scoring less than 4

suggests that the patient is unimpaired; a score from 4 to 9 suggests mild impairment;

scores higher that 10 suggest moderate to severe impairment.59

For the Information-

Memory-Concentration test, less than 4 errors suggests no impairment, 4 to 10 errors

suggests mild impairment, 11 to 16 errors suggests moderate impairment, and greater

than 16 errors suggests severe impairment.60

As with the MMSE, when reporting the results of the BDS, we encourage

clinicians to report which items were missed in addition to the total score.

The 7 Minute Screen

Like the BDS, the 7 Minute ScreenTM

(7MS; see below) was also developed for

use in dementia. In 1998 Solomon and colleagues published the first report of a

screening assessment they developed consisting of four subtests: Orientation (month,

date, year, day, time), Memory (16 items, 4 at a time, cued and uncued), Clock Drawing,


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and Verbal Fluency (naming animals in one minute).21

Unlike most tests, however, the

interpretation is performed automatically by entering the result of the four subtests into a

special calculator or web site (http://www.memorydoc.org), leading to a high or low

probability that the patient has Alzheimers disease. The calculated formula is based

upon the results of a logistic regression comparing sixty patients with Alzheimers

disease and sixty healthy control subjects. The 7MS demonstrates sensitivity, specificity,

test-retest reliability, and interrater reliability all greater than 90%. The test has been

validated in the primary care setting as a screening tool for patients over the age of

sixty,

61

and it has also been validated in other languages.

62,63

Advantages of this test include that it is sensitive, reliable, easy to administer,

takes little time, and the interpretation is performed automatically. Another advantage of

the 7MS is that both episodic and semantic memory are evaluated, episodic memory by

the Orientation and Memory subtests and semantic memory by the Verbal Fluency

subtest. Limitations include that it has been developed for and used in patients with or at

risk for dementia, and that a calculator is needed for interpretation.

If the result from the calculator reads HI, the patient has a high probability of

dementia characteristic of Alzheimers disease, and it is suggested that the patient

undergo a full diagnostic evaluation. It is cautioned (and we agree) that it is

inappropriate to diagnose Alzheimers disease based only on the results of the 7MS. If

the calculator reads LO, the patient has a low probability of dementia characteristic of

Alzheimers disease; in this circumstance the patient may or may not need further

evaluation depending upon the history and clinical setting. In less than 5% of cases the

calculator may also indicate that the data are insufficient to make a judgment; in this
http://www.memorydoc.org/http://www.memorydoc.org/


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situation either using other evaluation measures or re-screening the patient in 6 to 9

months would be appropriate.

Other tests

Although the Consortium to Establish a Registry for Alzheimers Disease

(CERAD) word list memory, recall, and recognition test was developed in part for

research studies, it has become one of the standards of care in clinical centers that

diagnose Alzheimers disease and other dementias.20

It consists of ten words to be

remembered which are repeated over three study-test trials, a ten minute retention

interval, a delayed recall test, and finally a twenty-word recognition test (ten studied and

ten unstudied words). There are several advantages to using this CERAD memory test.

Because separate scores are obtained for the encoding trials, delayed recall, correct

recognition, and false positive responses, it facilitates separating out performance on

these different aspects of episodic memory. Clinicians who are interested in using the

CERAD memory test can learn more about it and order materials from the CERAD web

site, http://cerad.mc.duke.edu.

The Drilled Word Span procedure,2,64

a useful bedside memory test, can be briefly

described as follows. First, the patients digit span (how many single digit numbers they

can repeat) is measured. Then, they are asked to memorize a list of words equal to one

less than the patients digit span. (For example, if their digit span is seven they are given

six words to remember.) The patient then recites the words back to the examiner, and the

process is repeated until the patient can recite the list correctly three consecutive times.
http://cerad.mc.duke.edu/http://cerad.mc.duke.edu/


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