How to test yourself for Alzheimer's disease: rapid tests

Tests

Watch the video if you are too lazy to read

Watch the video if you are too lazy to read

Alzheimer's disease is a neurodegenerative disease and the most commonly diagnosed form of dementia. The disease is named after the German scientist Alois Alzheimer, who was the first to describe the significant differences between dementia of neurodegenerative and vascular origin.

Alzheimer's disease is responsible for more than half of all diagnosed cases of dementia. At the same time, there is an increase in the number of cases around the world, mainly due to the aging of the world population.

Causes of Alzheimer's disease

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Work to establish the cause of Alzheimer's disease has been going on for many decades, but it is still not known for certain. There are only hypotheses, the most probable of which are the following:

• disturbances in the protein structures of neurons, complicating the transmission of signals between nerve cells and, ultimately, leading to their death.
• Infection of the brain by the bacterium Porphyromonas gingivalis, which lives in the oral cavity and causes gum disease.
• Accumulation of the beta-amyloid enzyme in the brain.

At the same time, factors that increase the likelihood of developing Alzheimer's disease are known for certain. The main ones are listed below:

• age;
• genetic predisposition;
• accumulation of aluminum in the body (in the brain in particular);
• arterial hypertension;
• smoking;
• overweight;
• diabetes;
• increased blood cholesterol levels;
• atherosclerosis.

Dementia test: Can you pass it?

The SAGE test is a simple and effective diagnostic method that includes questions on logic, mathematical examples, as well as tasks on the preservation of perception and memory. When performing the test, you should refuse the help of special tools, instruments, devices - anything that will allow you to find out the correct answer.

The method is characterized by high sensitivity and low probability of erroneous results. You can carry out diagnostics yourself, without the help of specialists or loved ones.

Can Alzheimer's disease be cured?

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Alzheimer's disease is a serious and incurable disease. As the disease progresses, a person develops cognitive impairment, worsens memory problems, develops speech disorders, executive functions, perception disorders, etc. At the stage of severe dementia, a person can no longer cope without outside help.

However, although Alzheimer's disease cannot be cured, modern medicine has methods that can stop or slow down the progression of the disease as much as possible. A responsible approach to the diagnosis and treatment of the disease allows a person to maintain cognitive functions until old age. Therefore, it is extremely important to identify signs of dementia at the earliest stages and consult a doctor in time for help. To do this, you need to know the symptoms of early manifestations of Alzheimer's disease.

Tests to identify specific cognitive impairments

In addition to the KSHOPS and mini-COG, in clinical practice, Alzheimer's tests are used in clinical practice to detect symptoms of AD as a text coupled with other simple tasks. The patient may be asked to repeat the movements after the doctor and name the general signs of the proposed objects. In addition to memory function, speech fluency, reflexes, praxis, gnosis, etc. are tested. Basic cognitive tests:

• Schulte test;
• CDR—Clinical Dementia Rating Scale;
• Hamilton scale;
• Khachinsky scale;
• general scale of violations;
• self-assessment of depression.

All of them are used primarily to differentiate Alzheimer's disease from similar pathologies or determine the severity of individual disorders.
These tests are carried out in a clinical setting, as a wide variety of brain functions are assessed, for which the researcher requires some experience. Tests to determine the presence of cognitive impairment

Early symptoms and diagnosis of Alzheimer's disease

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When Alzheimer's disease develops, memory is the first to suffer. In this case, a person forgets recently occurring events or information received, while a person continues to remember events and knowledge acquired in the distant past well.

If you suspect Alzheimer's disease, you should consult a psychiatrist. The doctor will first ask the patient to take one of the cognitive tests. If, based on the test results, the doctor concludes that there are no impairments in cognitive functions, then the diagnosis will end, and the patient can be sure that at the moment he is not at risk of Alzheimer’s disease. If the test results are unsatisfactory, the doctor will refer the patient for more accurate examinations. In particular, the most accurate of them is brain imaging (magnetic resonance, computer, two-photon emission, etc.), which allows you to obtain layer-by-layer images of the brain and study its structure in great detail.

Cognitive tests that detect early Alzheimer's disease are simple and can be done at home. This is especially important given the fact that many older people refuse to see a doctor, unwilling to admit that they need help and treatment. Below are the most common tests and techniques practiced in clinics around the world.

First signs of Alzheimer's

The disease develops gradually, but loved ones notice the irreversible consequences late. The first symptoms of Alzheimer's disease are often attributed to age. The following situations should alert relatives:

• an elderly person forgets what book he read yesterday, confuses the names of his grandchildren;
• spends a long time looking for glasses or a wallet, does not remember where he left it;
• puts the kettle on the stove and forgets to turn it off;
• has difficulty making purchases in a store;
• ceases to navigate in a familiar place;
• does not maintain hygiene;
• retells the same story repeatedly, thinking he is sharing it for the first time.

In Alzheimer's disease, problems begin in the part of the brain responsible for processing new information and learning. Pensioners at an early stage of the disease may well remember events that happened a long time ago, but have difficulty remembering events a month ago.

Often, old people themselves complain about memory problems or that they do not understand what others are telling them. These phenomena signal a developing disease.

Puzzle tests

Text from letters and numbers

People with Alzheimer's disease have difficulty reading. The text in the picture below can be quickly read and understood the first time only by a person who does not have problems with fluent reading. If a person sees only a meaningless set of letters and numbers, he may have a predisposition to Alzheimer's disease.

Extra digit

This is an attentiveness test. Ask the subject to find a six among the nines.

A healthy person will find a six in less than a minute. If a person takes more than a minute to complete this test, they may have a predisposition to Alzheimer's disease.

Optical-spatial activity

To complete this test, you will need to copy the following drawing onto paper.

Invite the subject to draw arrows from number to letter in increasing order: that is, from number 1 to letter A, then to number 2, etc. If a person connects the circles in the following order: 1-A-2-B-3-C-4-D-5-D, and the arrows do not intersect, the test is passed. If a person makes a mistake and does not notice it himself, he may have a predisposition to Alzheimer's disease. In this case, we recommend using more detailed tests (you will find them below).

Picture test

Researchers at the University of Louisville have found that solving a number of simple problems requires using the medial temporal lobes. However, they are among the first to be affected in Alzheimer's disease. This became the basis for the development of this diagnostic technique. The test is completely simple. The subject is presented with several series of pictures. Each includes 4 images: 3 of the same item (for example, a hat or cake) from different angles or a different color, and a fourth of a different one. The essence of the task comes down to finding the superfluous. Inability to solve a simple problem may indicate a predisposition to the disease.

Mini-Cog test

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The Mini-Cog test was developed at the University of Washington by Su Borson, an MD who specializes in dementia. The advantage of the test is its brevity and the ability to be performed by people who are not specialists in the medical field.

This short test is often used as part of the initial diagnosis of senile dementia of the Alzheimer's type and other types of dementia in older people. The Mini-Cog test allows you to evaluate a person’s short-term memory function, hand-eye coordination, and ability to perform tasks. It allows you to detect the development of Alzheimer's disease at the earliest stages.

Test rules

The test is quite simple and does not take more than five minutes. It consists of three actions:

1. The subject is given 3 words: orange, window, pyramid. A person must repeat them and try to remember them.
2. After which the subject must draw on paper a clock with hands indicating the time - twenty minutes to eleven.
3. Then the subject must remember and name 3 words.

Scoring and evaluation of results

For each correctly named word after drawing a clock, the subject receives 1 point.

3 points

– no dementia.

1-2 points

if the clock is correctly depicted, there is no dementia.

1-2 points

If there are errors in drawing a clock, dementia is suspected.

0 points

– dementia is suspected.

Scientific basis for the effectiveness of the test

Although this test is used throughout the world for the initial diagnosis of Alzheimer's disease, there are studies confirming that the results of the Mini-Cog test cannot be fully trusted.

Researchers from the Department of Psychiatry at Queen's University in Kingston, Canada, conducted a meta-analysis examining four studies of the sensitivity and specificity of the Mini-Cog test for detecting Alzheimer's disease in primary care settings. These studies examined 1,517 cases in which the results of the Mini-Cog test were compared with the results of a diagnosis carried out in accordance with standard criteria for detecting Alzheimer's disease. According to the results of a meta-analysis published in 2018, the sensitivity of the Mini-Cog test varies from 76 to 100%. The scientists concluded that at the moment, including due to the small number of studies, there is insufficient evidence to recommend the Mini-Cog test for the primary diagnosis of dementia. You will find a link to the study at the end of the article.

PREVALENCE AND RISK FACTORS FOR THE DEVELOPMENT OF ALZHEIMER-TYPE DEMENTIA

Ya. B. Kalyn, A. L. Bratsun

Scientific and Methodological Center for the Study of Alzheimer's Disease and Associated Disorders of the Scientific Center for Medical Sciences, Moscow

The relevance of the problem of late-life dementia and, first of all, dementia of the Alzheimer's type (ADT), currently united under the diagnostic heading “Alzheimer's disease” (AD), is steadily growing. This is explained by the frequency of AD/DAT, the long-term disabling course of the disease and the high economic costs of treatment and care for patients who, at an advanced stage of the disease, require lifelong placement in institutions for the chronically mentally ill. The mentioned circumstances led to the formation of a view of AD/DAT as an “epidemic of the 21st century” (Rocca W. et al., 1991) and the recognition of dementias, currently united under the name AD, as one of the main problems facing medicine today.

Epidemiological research in this area is of significant applied and fundamental interest. They allow, on the one hand, to assess the medical and social significance of the problem, including determining the volume and nature of the necessary medical and social assistance to patients and members of their families, and on the other hand, they make a significant contribution to the study of its etiology and pathogenesis. Attempts to establish the prevalence of late-life dementia, including DAT, have been repeatedly made in different countries of the world since the 60s. Despite the labor-intensive nature of population-based epidemiological studies, the number of such studies abroad is growing every year. In Russian psychiatry, only a few population studies of late-life dementia have been undertaken (Gavrilova S.I., 1984; Gavrilova S.I. et al., 1987; Kalyn Ya.B., Gavrilova S.I., 1997).

To study the prevalence in late age of various forms of mental pathology in general, and Alzheimer's disease in particular, as well as the influence on morbidity indicators of biological, constitutional-personal and socio-psychological (environmental) factors, at the National Center for Mental Health of the Russian Academy of Medical Sciences in 1992-1995. A comprehensive clinical and epidemiological study of the elderly population living in a limited area of ​​one of the districts of Moscow was carried out. The general characteristics of the examined elderly population, methodology and research strategy are presented in our previous publication (Kalyn Ya. B., Gavrilova S. I., 1997).

This report is devoted to the analysis of the prevalence of Alzheimer's disease among people aged 60 years and older and the influence of the main biological and environmental factors on this epidemiological indicator, as well as the study of risk factors for the development of AD and protective factors that presumably reduce the risk of the disease.

As the results of a population study showed, among the various causes of dementia in old age, late-onset Alzheimer's disease (senile dementia of the Alzheimer's type - S DAT) predominates. ADAT accounts for almost half of the cases of dementia in old age. SDAT was diagnosed in 50 elderly people, i.e., in 4.5% of the examined population. At the same time, 30 people (2.7%) had mild dementia and 20 people (1.8%) had clinically pronounced SDAT. Of the 20 patients with clinically significant dementia, 17 (1.5%) had moderate dementia and 3 (0.3%) had severe dementia.

In the surveyed population, the most common patients were patients with a simple form of SDAT - 11 people, i.e. 55.0% of patients with a clinically pronounced stage of the disease. In 5 patients (25.0%) ADAT with “Alzheimerization” was diagnosed. The psychotic form of the disease was diagnosed in 3 people (15.0%), and the paranoid form of late-onset Alzheimer's disease was found in 1 person (5.0%). Population data on the proportion of various clinical forms in the general structure of Alzheimer's disease of the senile type differ significantly from the prevalence rates of these same clinical forms among patients hospitalized in a psychiatric hospital (Kalyn Ya. B., 1990). In the population we studied, we found a significant predominance of forms of the disease with a later onset (simple and with “Alzheimerization”), which account for 80.0% of clinically significant late-onset Alzheimer’s disease. Forms of SDAT with a relatively earlier onset (presbyophrenic and paranoid) were significantly less common in the surveyed population. However, the noted differences are most likely due to the characteristics of behavioral disorders in these forms of the disease.

Of the many factors studied that presumably influence the population incidence of Alzheimer's disease (AD/AD), the greatest attention has been paid to the role of gender and age (Jablensky A., 1994; Ott A. et al., 1995; Yoshitake T. Et al., 1995) .

Data from an epidemiological study indicate that the population frequency of BA/DAT is steadily increasing with increasing age and amounts to 0.7%, 4.6%, 16.5% and 18.2%, respectively, in age groups 60-69, 70 -79, 80-89 and 90 or more years.

The tendency towards an increase in the prevalence of AD/DAT with aging is characteristic of both clinically pronounced and mild forms of the disease. The frequency of mild forms of Alzheimer's disease in the age groups 60-69, 70-79, 80-89 and 90 and older years is 0.5, 3.1, 8.9 and 9.1%, respectively. The prevalence of clinically pronounced forms of AD/DAT, i.e., moderate and severe dementia, in the age group of 60-69 years is 0.2%, in 70-79 years -1.5% and at the age of 80-89 years reaches 7 .6%. In the oldest age group of 90 years or more, the prevalence of clinically significant AD/DAT was 9.1%.

The analysis shows that among all patients with BA/DAT identified in the population, the proportion of people aged 80-89 years was 52.0%, while for the entire surveyed population this figure was more than 3.5 times less and equal to 14.2% (p<0.005). The proportion of people of the same age in the group of older people without mental disorders is even smaller - 7.2%. That is, the 80-89-year-old age period can be considered as the age of greatest susceptibility to the senile type of AD/DAT.

A slight decrease in the incidence of asthma/DAT in the age group of 90 years and older may be associated with a relatively small proportion of centenarians in the population we examined. However, there is evidence of a higher mortality rate in patients with Alzheimer's disease compared to the general population of the same age. It can also be assumed that species limits on human lifespan often do not leave time for the development of the disease after 90 years of age. Based on such assumptions, one would expect a significant reduction in the proportion of centenarians among patients with Alzheimer's disease, compared with older people without mental disorders. However, the results of the study indicate that the proportion of centenarians among identified patients with AD/DAT and among mentally healthy individuals of the same age is quite comparable: 2.0% and 2.2%, respectively (p>0.05). Therefore, it can be assumed that after 90 years of age, the risk of developing Alzheimer's disease decreases compared to the previous decade, although this assumption requires clarification.

In modern specialized literature, much attention is paid to the role of gender in the development of mental pathology in general, and Alzheimer's disease in particular. The prevailing opinion is that the risk of developing Alzheimer's disease in women is higher than in men (Bettini R. et al., 1992; Jablensky A., 1994; Ott A. et al., 1995). The results of our study indicate a more frequent occurrence of BA/DAT in the older female population, respectively 5.1% for women and 2.9% for men (p<0.05). In the elderly female population, both mild DAT (3.1%) and clinically pronounced DAT (2.0%) are more common. Among men of the same age, the incidence of mild dementia is 1.6%, and clinically significant DAT is 1.3%. However, not in all older age periods the prevalence of BA/DAT among women is higher than among men, as evidenced by the data in the table.

In the age group of 70 - 79 years, the frequency of BA/DAT in men exceeds that for the female population, although the differences are statistically insignificant (p>0.05). The results of the study indicate that only at the age of 80-89 years the frequency of BA/DAT among women is significantly higher (p <0.05) than among men of the same age. It is difficult to give a reasoned explanation for this phenomenon. It is possible that a significant proportion of men who would develop Alzheimer's disease die before reaching the risk age for developing the disease.

Table. Prevalence of AD/DAT (per 100 examined persons of the corresponding age) depending on gender, age and severity of dementia (stage)

Mild dementia Moderate and severe dementia Total

Relatively less attention has been paid to studying the influence of so-called microenvironmental factors on the population prevalence of Alzheimer's disease - level of education, professional activity and lifestyle. The results of the study indicate that among patients with AD/DAT there were significantly more people with a low level of education (0-4 years of education) compared to the examined elderly people without mental disorders (p <0.005). There was a tendency towards a predominance of persons with a low professional level among patients with BA/DAT compared to healthy people, although the differences did not reach the level of statistical significance (p>0.05). It was found that in the group of patients there were significantly more widows (p<0.005) and significantly less often (p<0.005) older people living in marriage compared to people of the same age without mental disorders.

The role of a number of microenvironmental factors in the genesis of AD/DAT was studied using a different methodological approach - the method of paired controlled research (Vrachui A.L., 1999). The work was based on an assessment (using a standard questionnaire) of the occurrence of presumptive risk factors for asthma in the family history or life history of individuals included in the study. The frequency of the mentioned signs was compared in the group of patients with AD/DAT and in the control group of persons selected (using the paired control method) by coincidence in pairs of sick and healthy persons of gender, level of education (primary, secondary, higher) and age (within 5 years interval). For statistical processing of the results, we used the determination of the relative risk ratio (OR), the level of reliability of this indicator (p) according to the McNemar test (NE Breslow, N. E. Day, 1980), as well as the confidence interval (CI ) at the level of 95% statistical probability. The indicator is considered as a risk factor (RF) for this disease at p<0.05 and the lower limit of CI>1 and as a protective factor (PF) - at p<0.05 and the upper limit of CI<1.

Analysis of the results of the study showed that in the general group of patients with DAPT, the most significant risk factor for the development of the disease is the presence of second cases of late-life dementia in first-degree relatives (RR = 35; 95% CI 5.67-999).

The significance of a past traumatic brain injury that occurred with signs of a concussion (without loss of consciousness) in pairs of patients with DAT and healthy subjects was determined as a risk factor for the development of DAT at the level of statistical significance (OR = 5.3; 95% CI 1, 78-19).

According to the applied method of statistical analysis, a significant protective factor for DAT turned out to be a history of acute, including frequent, psychotraumatic situations (respectively: AOR = 0.3; 95% CI 0.14-0.67 and AOR = 0.3 ; 95% CI 0.1-0.59).

The AOR value for the smoking factor turned out to be at the borderline level of significance as an AF (AOR=0.3; 95% CI 0.05-1.17; p=0.96). This allows us to consider smoking only as a conditional AF for the development of DAT.

For the DAT group, the presence of a history of chronic inflammatory disease of the biliary tract turned out to correspond to the AF value according to DAT (OR = 1.4; 95% CI 0.007-0.91) at the level of statistical significance. The significance of a history of coronary heart disease with angina pectoris was at the borderline level of statistical significance as AF according to DAT (OR = 0.4; 95% CI 0.1-1.05, p = 0.07).

The obtained results of the studies confirm the main conclusion of many population epidemiological studies, including a re-analytical collaborative study of the incidence of asthma in the EEC countries (Rocca W. et al., 1991), about the exponential increase in morbidity rates in both female and male populations as the population increases. age. The morbidity rates of AD/DAT, according to a survey of the Russian population, are slightly higher than similar pan-European indicators, which may be due to both methodological features of the research and socio-psychological factors inherent in modern Russia. Unlike most European studies, where the initial screening of patients with asthma was carried out using scales without the participation of a psychiatrist, in the domestic study the initial examination was carried out by a geriatric psychiatrist, which significantly increased the detection of mental disorders. However, it cannot be ruled out that the global stress of the current situation in Russia could affect the resistance of part of the surveyed population to the effects of unfavorable environmental factors that are considered characteristic of the aging period. This, in turn, could contribute to the exacerbation of some forms of endogenous and organic cerebral pathology, and in particular, the mild form of BA.

In many studies, including reanalytic ones (Bachman D. et al., 1992; Hafner H., 1990), it was found that the prevalence rates of AD/DAT among women are higher than among men of the same age. However, some researchers (Fratiglioni L., 1993) did not find significant differences in the prevalence of BA/DAT among both sexes in the age groups 75-79 and 80-84 years, and only at a later age the incidence of the disease is significantly higher in women, than men.

Some researchers have suggested that a low level of education not only affects the detection of dementia, but also determines the predisposition to the development of dementia. According to R. Katzman (1993), intellectual activity, especially at an early age, leads to the formation of additional connections between neurons (springing), which in the future may be an obstacle to the development of AD/DAT. In our opinion, the influence of the level of education on population indicators is also mediated by many other factors derived from the level of education, such as professional and production conditions, material and living conditions, lifestyle, etc.

Data that adverse life events occur significantly more often in the lives of patients with AD/DAT than in healthy individuals of the same age were confirmed in some foreign epidemiological studies (Bidzan L., 1994). Perhaps such a common factor as widowhood in old age is a serious factor, both psychologically traumatic and violating the life stereotype.

The significant connection between the probability of the disease and the presence of second-degree cases of dementia (presumably Alzheimer's type) in first-degree relatives of patients revealed in the study is fully consistent with previously published data from foreign controlled epidemiological studies (Amaducci L. et al., 1986; Graves A. et al., 1987; McDowell I. et al., 1994, etc.).

The identification of the significance of smoking as AF against the development of DAT in epidemiological studies performed earlier (Graves A. et al., 1991), which was partly confirmed in this work, is presumably associated with chronic stimulation of nicotine-dependent receptors, which leads to constant activation of the cholinergic system, which , according to D. Brenner et al. (1993), may prevent or delay the development of DAT.

The protective significance of some somatic diseases revealed in the study (in particular, ischemic heart disease with angina pectoris and chronic inflammatory diseases of the biliary tract) requires explanation. Currently, the participation of inflammatory and autoimmune processes in the pathogenesis of DAT is considered proven (Kolyaskina G.I. et al., 1996; Burbaeva O.A. et al., 1996; HartwigM., 1995). Since patients with coronary artery disease usually take anticoagulants for a long time, and among them most often aspirin, which has an anti-inflammatory effect, it can be assumed that perhaps it is the anti-inflammatory effects of aspirin that reduce the risk of DAT. Some previously performed controlled epidemiological studies (McDowell Let al., 1994; Breitner J. et al., 1994; Rich J., 1995) established the protective role of anti-inflammatory (nonsteroidal) drugs for the development of DAT, which may confirm the assumption that the possible protective role of therapy with aspirin, and possibly other medications used to treat coronary artery disease. The possible protective role of such a feature as the presence of chronic diseases of the biliary tract can be explained by the peculiarities of the anti-inflammatory therapy or dietary regimen used for chronic inflammatory diseases of the biliary tract. However, this issue requires further special study on a larger sample.

In the study, no patterns were established in relation to a number of factors described in the literature and studied by us, which may be due to the insufficient number of pairs of sick and healthy subjects studied. This is confirmed by the fact that only a reanalysis of the total data of all controlled epidemiological studies conducted in the world made it possible to establish such risk factors for DAT as the late age of the mother at the time of the birth of the future patient (Rocca W. et al., 1991), the presence of Down's disease and/ or Parkinson's disease in first-degree relatives (vanDuijn S. et al., 1991). In the majority of individual studies (with a limited number of patients and controls), the relationship between these factors and the development of DAT turned out to be statistically insignificant.

Based on the results of the study, with a certain degree of caution, it can be argued that the effects of environmental factors damaging the brain increase the risk of developing DAT. At the same time, environmental factors involved in one way or another in the mechanisms of neuroprotection or in the activation of neurotransmitter systems involved in the pathogenesis of the disease can obviously reduce the risk of developing the disease.

To clarify the significance for the Russian population of a number of other environmental RFs and AFs according to DAT, which were established for European and other populations, it is necessary to conduct studies on more numerous pairs of patients and healthy subjects or conduct targeted cohort studies with a large number of both patients and age-related controls .

Literature.

1. Bratsun A. L. Risk factors for dementia of the Alzheimer’s type: Abstract. Dis to-ta honey. Sciences, M., 1999, 21 p.

2. Gavrilova S.I. Mental disorders in the elderly and senile population (clinical-statistical and clinical-epidemiological research): Abstract of thesis. Dis Dr. med. Sciences, M., 1984, 43 p.

3. Gavrilova S.I., Sudareva L.O., Kalyn Ya.B. Zhurn. neuropathol. and a psychiatrist. 1987; 87:9:1345-1352.

4. Kalyn Ya. B. Ibid. 1989; 89: 9: 78-85.

5. KalynYa. B., GavrilovaS. I. //Reforms of mental health services: problems and prospects. Proceedings of the international conference October 21-22, 1997 - Moscow, 1997: 181-189.

6. BettiniR., GobbiG., LandonioM. et al. Clin Ter 1992; 140(3): 225-233.

7. BidzanL. Psychiatria Polska 1994; 28: 2: 2011-2019.

8. DohrenwendB. ActaPsychiatScand 1994; 90 (supp 385): 13-20.

9. FratiglioniL., Ahlbom A., ViitanenM., WinbladB. Ann. Neurol. 1993; 33: 258-266.

10. KatzmanR. Clin Neurosci 1993; 1:165-170.

11. Jablensky A. Acta Psychiat Scand 1994; 90 (supp 385): 23-24.

12. Rocca WA, Hoffmann A, BrayneC. et al. Annal Neurol 1991; 30:3:384-390.

13. YoshitakeT., KiyoharaY., KatoI. et al. Neurology 1995; 45: 6:1161-1168.

Test "Drawing a clock"

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A very popular test for the initial diagnosis of Alzheimer's disease is drawing a clock face. This test is used in many methods of studying cognitive functions (including the Mini-Cog test described above).

The “Clock Drawing” test was developed more than a century ago – back in 1915. However, in those days it was used to diagnose aphasia and apraxia. It was only in 1989 that this test began to be used to diagnose cognitive impairment (link to material at the end of the article).

Exercise

Give the person a piece of paper and a pencil and ask them to draw a large round clock face with numbers and hands so that the clock indicates the time 11:10. The drawing is scored in points from 0 to 4. Only a result of 4 points is considered a sign of complete health. The lower the score, the more severe the Alzheimer's disease or other type of dementia.

Evaluating a drawing

To rate a drawing, add 1 point for each part:

1 point

for a vicious circle;

1 point

for depicting the numbers in the correct places on the dial;

1 point

for depicting all 12 numbers on the dial;

1 point

for correctly placed arrows.

Decoding the test result

Add up all points scored. If 4 points are scored, there is no dementia. Any result below 4 suggests Alzheimer's disease or another type of dementia. The more mistakes the subject makes in drawing a clock, the higher the severity of dementia.

Scientific basis for the effectiveness of the test

Scientists at University Hospitals Cleveland (Ohio, USA) conducted a study to determine the effectiveness of the Clock Drawing test for detecting Alzheimer's disease in the earliest stages, as well as to identify the most useful drawing elements for diagnosing this disease. The clock drawings of 41 patients over 39 years of age with MMSE test scores (presented below) of 24 points or higher were analyzed.

Based on the results of the study, scientists came to the conclusion that the most important diagnostic value is the image of the clock hands

. If you make two or more mistakes when drawing clock hands, there is a high probability of developing Alzheimer's disease in a person. In turn, the correct image of the clock hands does not exclude the possibility of developing Alzheimer's disease, but such a possibility is unlikely. You will find a link to the study at the end of the article.

SLUMS test

In the SLUMS (Saint Louis University Mental Status) test for dementia, the test taker is asked to answer 11 questions. The number of points for the correct answer is indicated in brackets:

1. What day of the week is it now (1).
2. What year (1)?
3. Where are we (1)?
4. Remember 5 words (apple, pen, tea, house, car). They will need to be repeated later.
5. Solve the problem. Having 100 rubles, the boy buys apples for 3 rubles and a bicycle for 20 rubles. How much did he spend (1), how much money did he have left (2).
6. Remember and name as many animals as possible in a minute. (0 for 0-4 animals, 1 for 5-9, 2 for 10-14, 3 for 15 or more).
7. Remember the words from point 4. For each correctly named word, 1 is added.
8. Say the indicated number in reverse order. Score 0 for two-digit numbers, 1 for three- and four-digit numbers.
9. On the dial, draw the clock hands at 10-50. If drawn and named correctly, then 2 are added.
10. Find a triangle among the three figures. Name the largest of the three figures. (1 for each correct answer).
11. Listen to a short story and answer 4 simple questions based on the content. Correct answers are awarded 2 points; a total of 4 questions are asked.

In paragraph 11, make up a short story, which indicates the location, time, season of the year, and the name of the character. Having finished the story, the subject is asked to repeat these data.

A person with higher education who does not suffer from dementia should score 27-30. If the sum is 21-26, then this indicates a slight cognitive impairment. A score between 0 and 20 indicates moderate dementia.

Mini-Mental State Examination (MMSE)

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The Mini Mental State Examination (MMSE) is a short 30-point test that assesses the state of cognitive function and the degree of impairment. It is widely used in various clinics for the initial diagnosis of Alzheimer's disease, as well as for screening as it is treated.

MMSE was developed in 1975 by psychiatrists Marshall Folstein, Susan Folstein and Paul McHugh. Since then, this test has undergone minor changes, and is still used today in clinics around the world.

If anyone in your family complains of problems with short-term memory, concentration, mental arithmetic, speech, or other cognitive functions, suggest taking this test. It is quite simple and can be done at home.

Testing instructions

Orientation in time and space

The test subject must correctly name today's date, month, year, as well as the day of the week and time of year. Also, a person must correctly name his location: the name of the country, locality, region, house number or name of the institution, floor.

For each correct answer, 1 point is counted. For an incorrect answer - 0 points. Thus, the subject can receive from 0 to 10 points.

Perception

Ask the subject to remember three words that you tell him. Then say three words slowly and clearly: orange, window, pyramid (other option: apple, carpet, key). Then ask the person to say them.

For each word reproduced, 1 point is counted. Thus, the subject can receive from 0 to 3 points.

Concentration and mental arithmetic

Ask the subject to subtract the number 7 from the number 100 five times in succession (calculations must be done mentally). Thus, he must name 5 answers: 93, 86, 79, 72, 65. For each correct answer, count 1 point.

If the subject does not want to make calculations, offer another task: pronounce the word “EARTH” backwards. Score 1 point for each letter pronounced correctly. In other words, if the answer is correct, the subject must say “YALMEZ”, and he will be given 5 points. If the subject says “YAMLEZ”, only 3 points will be counted, etc.

Short-term memory

The subject must remember and say 3 words that you asked him to remember during the perception test. For each correct word, 1 point is counted. Thus, the subject can receive from 0 to 3 points.

Oral speech

Show the subject a wristwatch and ask him to name this item. Do the same with a stationery pen. For each correct answer, count 1 point.

Ask the subject to say the phrase “no ifs, ands, or buts.” If the phrase is pronounced without errors, count 1 point.

Thus, this task can be scored from 0 to 3 points.

Action in 3 stages

Give the subject a sheet of blank paper and say the following: “Take the sheet in your right hand, fold it in half and place it on the floor.” For each correctly performed action, count 1 point. The maximum number of points is 3.

Reading

Give the subject a piece of paper on which the command “CLOSE YOUR EYES” is clearly and legibly written, and ask him to do what is written on the sheet. If the subject closes his eyes, count 1 point.

Letter

Give the subject a blank sheet of paper and ask him to come up with and write down a meaningful sentence on any topic that will contain a noun and a verb. Spelling, grammatical and punctuation errors do not matter in this case. If the patient wrote a sentence, score 1 point.

Copying a drawing

Give the subject a blank sheet of paper and a sample drawing that shows two intersecting equiangular pentagons (as in the picture below). Ask to copy the drawing exactly. If the subject has drawn both pentagons, their lines are connected, and they intersect as in the sample, 1 point is counted. If one of the figures has more/less angles, the lines are open or the figures do not intersect, the point is not counted.

Test result evaluation

The result is calculated by summing the points scored for each test task. The maximum possible score is 30 points, which corresponds to a normal state of cognitive functions. The lower the total score, the more severe the degree of dementia. The result, depending on the amount of points scored, is interpreted as follows:

• 28 – 30 points:
  cognitive abilities are normal.
• 24 – 27 points:
  there are cognitive impairments.
• 20 – 23 points:
  mild dementia.
• 11 – 19 points:
  moderate dementia.
• 0 – 10 points:
  severe dementia.

Scientific basis for the effectiveness of the test

Scientists at the University Foundation for Medical Sciences (Bogotá, Colombia) conducted a meta-analysis to investigate the effectiveness of the MMSE test for detecting Alzheimer's disease in people with mild cognitive impairment. The meta-analysis pooled and analyzed the results of 11 heterogeneous studies that examined data from 1569 patients with mild cognitive impairment.

In the meta-analysis, the researchers found no evidence to recommend the MMSE test as the sole diagnostic tool for identifying patients with mild cognitive impairment who are at risk of developing Alzheimer's disease. Doctors are recommended to use additional diagnostic methods in addition to the MMSE test. You will find a link to the study at the end of the article.

Brief tests for dementia

Signs of early dementia are easier to notice for the patient's relatives. The easiest way to check whether a person has dementia is to ask what they had for breakfast in the evening.

If a person has cognitive impairment, he will no longer remember what he did in the morning and will not be able to answer this question.

But the first manifestations of dementia are not always so obvious. To detect early dementia, you can use short tests designed specifically for self-administration.

Test 1: assessing the ability to live independently

The study is aimed at identifying and assessing the impact of mental impairment on the ability to live independently. The test is scored in points:

• 0 – no violations;
• 0.5 - moderate violations;
• 1 – lack of skill.

To assess daily activity, they answer whether skills are lost:

1. Ability to work around the house.
2. Handling money.
3. Ability to remember short lists of words.
4. Navigate in a confined space.
5. Find your way around familiar areas.
6. Ability to distinguish buildings and recognize people.
7. Remember recent events.
8. Adapt to new living conditions.

If the score is 8, the maximum number of points, then this indicates severe dementia. A score of 3-7 points indicates a moderate degree of dementia.

If the subject scored 1-2, this indicates a mild cognitive disorder. A patient with no cognitive impairment will score 0.

Test 2: Determining Dementia Risk

From the proposed answer options, only one is selected. The number of points for the answer is indicated in parentheses.

Level of Memory Loss:

• No memory loss (0).
• Partial loss of memory of nearby events (0.5).
• Significant forgetting of nearby events (0.5).
• Retention of long-term memories with loss of memory of close events (0.5).
• Loss of immediate memory and fragmented long-term memory (1).

Degree of disorientation in time and space:

• There are no violations (0).
• Slight difficulties in determining the current day, hour, month (0.5).
• Difficulties in determining time and tense situations with orientation in familiar areas (0.5).
• Daily problems with orientation in time and space (0.5).
• Inability to navigate (1).

Problems with solving logic problems:

• Copes with business as usual (0).
• Small problems arise with solving already familiar problems (0.5).
• Doing routine work causes stress (0.5).
• There are difficulties in communication and problems at work (0.5).
• The ability to make decisions and communicate with others disappears (1).

Degree of independence at home and outside its walls:

• Independent operation (0).
• There are minor difficulties when choosing goods (0.5).
• Outside the home he feels insecure and loses the ability to act independently (0.5).
• Unable to function outside the home, but continues to perform some functions at home (0.5).
• The ability to act both at home and outside its walls is lost (1).

Having a hobby:

• Common hobbies and interests (0).
• Problems arise when doing housework (0.5).
• Complex hobbies disappear, but simple chores are completed (0.5).
• Errors also occur when performing simple tasks (0.5).
• Unable to do work at home, cannot find anything to do (1).

Self-care ability in terms of hygiene:

• Capable of full self-care (0).
• Able to take care of himself in terms of hygiene, but is lost when choosing clothes (0.5).
• Sometimes needs help (0.5).
• Suffers from urinary and fecal incontinence and often cannot cope with normal hygiene procedures (1).

Transcript of the test

If the score is 0, then there is no likelihood of dementia. If the score is 0.5, then dementia or mild cognitive impairment is questionable. With a score of 1, mild dementia is diagnosed.

A score of 2 indicates moderate dementia, and a score of 3 indicates severe mental impairment.

Mild cognitive impairment is diagnosed after age 65 in 20% of adults of both sexes. The stage of mild cognitive impairment does not necessarily worsen and progress to dementia. Under favorable conditions, the disease can remain at the same stage for another 4-7 years.

The stage of mild dementia usually lasts 2-4 years. But the disease can accelerate if an elderly person is isolated and does not have the opportunity to engage in hobbies.

If the subject scores 2 or 3, then the symptoms are usually so pronounced that a visit to a psychiatrist is required to evaluate his condition.

Test 3: assessing the degree of personality change

Cognitive disorders are manifested by changes in character. To assess the degree of violation, changes in the habits, character, and emotional background of the person being tested are assessed.

For each item, a certain number of points are awarded, which are summed up after passing the test.

How the subject eats is assessed:

• 0 – eats correctly, uses cutlery;
• 1 – eats using only a spoon, sloppy;
• 2 – cannot use cutlery, eats with hands;
• 3 – outside help is required to eat.

Assessment of the dressing process:

• 0 – copes with dressing himself;
• 1 - minor difficulties arise (fastening buttons, zippers);
• 2 – puts on items of clothing out of sequence;
• 3 – cannot dress himself.

Functions of the bladder and bowels:

• 0 – no violations;
• 1 – cases of involuntary urination are rarely observed;
• 2 – involuntary urination occurs frequently;
• 3 – fecal and urinary incontinence is noted.

A sign of early dementia may be a change in personality traits. When a person develops new habits or changes in character, a brain disorder can be assumed and a test for dementia can be performed.

Negative personality traits that indicate an increased risk of dementia include:

• coarseness;
• stubbornness;
• emotional coldness;
• causeless euphoria;
• selfishness;
• fussiness;
• apathy;
• hypersexuality;
• indifference to the experiences of loved ones;
• irritability;
• loss of usual interests.

If there are no changes in character, then a 0 is given. 1 is added if traits have appeared that were not previously observed in the subject’s character, or they have increased significantly.

A total score of 17-20 points on the test indicates a severe degree of dementia. If the test taker scored 8-16, this means a moderate degree of dementia.

A score from 0 to 4 indicates normal cognitive function. And indicators of 4-8 points correspond to a mild degree of cognitive impairment.

Test 4: indicator of decline in intelligence

You can test your ability to concentrate, the volume of short-term and long-term memory yourself by following simple questions. One point is awarded for the correct answer.

The subject is asked to name:

• own name;
• age;
• current time;
• Times of Day;
• today's day of the week;
• today's date;
• season;
• indicate what year it is.

The following questions concern orientation and the patient is asked to indicate:

• street;
• city;
• determine location (hospital, home).

The safety of personal memory is examined by asking questions:

• state your date of birth;
• indicate place of birth;
• what school did you go to;
• what profession did you receive;
• they check the ability to recognize others (doctor, nurse, relative);
• asked to name the names of sisters and brothers;
• they ask you to remember the city in which you worked before;
• name your boss or co-worker.

When examining long-term memory, they ask simple questions regarding history, asking them to name:

• the date of the start of the First World War;
• indicate the date of the beginning of the Second World War;
• the name of the current president of the country;
• the name of the country's previous president.

The Alzheimer's Questionnaire

© Jivko / Canva

This questionnaire will help you determine whether someone close to you has Alzheimer's disease or whether there is no reason to worry. The test evaluates all of a person's abilities that are affected by the development of dementia. The questionnaire consists of 21 questions. For each affirmative answer, 1 or 2 points are counted, for a negative answer - 0 points. The higher the score, the higher the likelihood of dementia.

Memory

1. Does your loved one have a bad memory? (Yes – 1, no – 0)
2. If there are problems, have they gotten worse in recent years? (Yes – 1, no – 0)
3. Does your loved one ask the same questions, repeat the same stories throughout the day? (Yes – 2, no – 0)
4. Does he forget about planned activities or visits? (Yes – 1, no – 0)
5. Does he lose things more than once a month? OR puts things in random places and then can't find them? (Yes – 1, no – 0)
6. Does he express suspicions that things are being hidden, shifted or stolen from him when he finds it difficult to find them? (Yes – 1, no – 0)

Orientation in time and space

1. Does your loved one often have difficulty remembering the time of day, today’s date, month, year? OR does he use the calendar or other sources several times a day to remember today's date? (Yes – 2, no – 0)
2. Does he become disorientated in unfamiliar places? (Yes – 1, no – 0)
3. Does he experience uncertainty and confusion when away from home or when traveling? (Yes – 1, no – 0)

Functionality

1. Does your loved one have difficulty handling money, such as calculating change when shopping? (Yes – 1, no – 0)
2. Does he have difficulty paying bills or handling finances? (Yes – 2, no – 0)
3. Do his memory problems affect how regularly he takes his medications? (Yes – 1, no – 0)
4. Does your loved one have difficulty driving? OR did he stop driving for reasons unrelated to physical limitations? (Yes – 1, no – 0)
5. Does he have difficulty operating household appliances (microwave oven, stove, alarm clock, etc.)? (Yes – 1, no – 0)
6. Does he have difficulty (not related to physical limitations) with chores? (Yes – 1, no – 0)
7. Has your loved one given up or significantly reduced the time devoted to previous interests (sports, fishing, favorite craft, etc.) for reasons unrelated to physical limitations? (Yes – 1, no – 0)

Visuospatial orientation

1. Does your loved one get lost in familiar places (not far from their own home)? (Yes – 2, no – 0)
2. Does it happen that he chooses the wrong direction of movement? (Yes – 1, no – 0)

Speech

1. Does it happen that your loved one cannot remember the appropriate words in a conversation (except names and titles)? (Yes – 1, no – 0)
2. Does he confuse the names of family members or close acquaintances? (Yes – 2, no – 0)
3. Does it happen that your loved one does not immediately recognize a person they know? (Yes – 2, no – 0)

Decoding the results

If you received less than 5 points

, this means your loved one does not have signs of dementia.

If the result is between 5 and 14 points

, your loved one should seek medical help because he has signs of mild cognitive impairment, which in the future may develop into dementia, incl. Alzheimer's type.

If you received more than 14 points

, it is likely that your loved one has already developed dementia and needs to seek medical help as soon as possible.

Development and scientific substantiation of the effectiveness of the questionnaire

In November 2010, a pilot project of the above questionnaire was published in the journal Alzheimer's Disease. Its development, analysis and research were carried out by a group of scientists with the support of the Banner Sun Health Research Institute (Arizona, USA) and a number of other scientific and medical centers. Scientists investigated the effectiveness and feasibility of using the above questionnaire for a more informative assessment of dementia.

During the study, the questionnaire was completed by informants of 188 patients, 50 of whom had normal cognitive abilities, 69 had mild cognitive impairment, and 69 were diagnosed with Alzheimer's disease. According to the results of the study, high sensitivity and specificity of this questionnaire was found to detect both mild and severe impairment of cognitive functions. At the same time, scientists noted that this questionnaire is not intended to completely replace the diagnostic examination of people with cognitive impairment. The full text of the study can be found at the link at the end of the article.

How to identify dementia yourself?

The likelihood of developing dementia increases with age and is most common in people over 65 years of age. The disease is one of the factors causing significant limitations in the functional capabilities of older people. This condition is difficult to bear not only for the patient himself, but also for all his loved ones and society. A number of disorders that directly damage brain tissue can lead to the development of the disease:

• Alzheimer's disease;
• cardiovascular diseases;
• head injuries;
• malignant and benign tumors.

The course of the disease goes through several stages, during which the patient’s condition worsens with a certain intensity.

Mild dementia is characterized by symptoms traditionally associated with old age. Among them: mild memory impairment, difficulty performing complex tasks that require special attention or ingenuity.

With moderate dementia, the patient practically loses the ability of short-term memory, can easily lose the logic of a story, or experience difficulty making important decisions. This degree of development of the disorder occurs with pronounced physiological disturbances: sleep disorders, auditory and visual hallucinations, weakness and irritability. Senile pseudo-melancholy manifests itself - lack of emotion and indifference even to important events.

Severe dementia manifests itself in the patient’s inability to recognize even relatives, establish any contacts with others, or simply satisfy independently the basic needs necessary to maintain life.