New 15-minute assessment opens up possibilities for early detection of dementia

At the World Congress of Neurology in Kyoto a group of Indian researchers presented a new 15-minute assessment to monitor dementia patients on an ongoing basis. The reliable telephone interview assessment technique opens up new possibilities for early detection as well as treating and monitoring Alzheimer's patients.

All it takes is a 15-minute telephone conversation to reliably differentiate between patients with normal cognition and those with mild cognitive impairment (MCI), and to detect progression from MCI to development of Alzheimer's disease. This was confirmed by the results of a comparative study from India presented at the XXIII World Congress of Neurology. This large-scale international scientific conference is taking place from September 16 to 21 in Kyoto. The study evaluated a new monitoring technique for conducting follow-up tests developed by a team of Indian neurologists and psychologists.

Ongoing assessment is a particularly important part of monitoring neurological deficit, whether with regard to mild forms of cognitive impairment or pronounced Alzheimer's disease. While experts already have a number of test instruments at their disposal, which they can use to differentiate between various forms of impairment and identify progression of disease, they tend to be complex and can easily overwhelm healthcare infrastructure in populous and less developed nations.

A group of Indian experts who are trying to broaden the spectrum of tools available has developed a new kind of test which can be conducted in a short telephone interview. Known as the FACT test (fifteen-minute assessment of cognition over the telephone), it comprises 27 items designed to test the interview subject's attention, verbal learning and memory, executive functions/language and orientation. "Our aim was to determine whether it was possible to diagnose dementia in just 15 minutes for people who were unable to visit hospitals," explained the study's author, Dr Ratnavalli Ellajosyula, cognitive neurologist expert at the Manipal Hospital in Bangalore.

In order to establish whether FACT is a similarly reliable method to established tests, the Indian researchers analysed the effectiveness of the questionnaire in study conditions. This involved conducting telephone interviews with 22 patients that suffered from mild cognitive impairment, 20 who had been diagnosed with Alzheimer's and a further cohort of 23 healthy patients of similar age and with similar educational background. The participating patients completed the established Addenbrookes Cognitive Examination (ACE III) in hospital a week before the telephone interviews.

The results gave the test's developers grounds for optimism: "We were able to show that FACT is comparable with and as efficient as ACE III, due to the fact being an instrument for determining mild cognitive impairment and for monitoring Alzheimer's," states Dr Ellajosyula. "This enables new possibilities in everyday clinical practice, for early-intervention research and for monitoring the progression of cognitive impairment."

The researchers hope that FACT would be used as a screening tool in epidemiological studies in the future. "This will circumvent the problem of people being uncooperative in door-to-door surveys or are not reachable or accessible. In India, mobile phones have a wide reach and being used across the country by all sections of the people", Dr Ellajosyula says. "In addition, FACT can be used for diagnosis of MCI, monitoring patients to see who will convert to AD and also to measure progression in AD, even to evaluate the response to medication in a drug trial.  Further studies are required but we hope to see it used also in other countries and resource poor settings where neuropsychologists are uncommon."