The Brief Memory and Executive Test (BMET) for detecting vascular cognitive impairment in small vessel disease: a validation study

BMC Medicine

Hugh S Markus¹  Robin G Morris³  Usman Khan²  Matthew J Hollocks¹  Rebecca L Brookes² 

[1] Department of Clinical Neurosciences, University of Cambridge, Addenbrookes Biomedical Campus, Cambridge CB2 0QQ, UK;Stroke and Dementia Research Centre, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK;Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK

关键词: Vascular dementia;    Memory;    Executive function;    Cognitive disorders;   

Others  :  1140490
DOI  :  10.1186/s12916-015-0290-y

 received in 2014-11-12, accepted in 2015-02-10,  发布年份 2015

【 摘 要 】

Background

Cognitive impairment is common in patients with cerebral small vessel disease, but is not well detected using common cognitive screening tests which have been primarily devised for cortical dementias. We developed the Brief Memory and Executive Test (BMET); a rapid screening measure sensitive to the impaired executive function and processing speed characteristic of small vessel disease (SVD). To assess the BMET’s validity for general use, we evaluated it when administered by non-psychologists in a multicentre study and collected control data to derive normative scores.

Methods

Two-hundred participants with SVD, defined as a clinical lacunar stroke and a corresponding lacunar infarct on MRI, and 303 healthy controls aged between 40–90 years old were recruited. The BMET, as well as the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE), were performed. Overall, 55 SVD participants underwent repeat testing at 3 months to assess the BMET test-retest reliability.

Results

Administering the BMET took a mean (SD) of 12.9 (4.7) in cases and 9.5 (2.6) minutes in controls. Receiver Operator Curve analysis showed the BMET was a good predictor of cognitive impairment in SVD (AUC = 0.94) and performed significantly better than both the MoCA (AUC = 0.77) and the MMSE (AUC = 0.70). Using a cut-off score of 13, the BMET had a sensitivity of 93% and specificity of 76% for detecting cognitive impairment in SVD.

Conclusions

The BMET is a brief and sensitive tool for the detection of cognitive impairment in patients with SVD.

【 授权许可】

   
2015 Brookes et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Erkinjuntti T, Gauthier S: The concept of vascular cognitive impairment. Front Neurol Neurosci 2009, 24:79-85.
• [2]Moorhouse P, Rockwood K: Vascular cognitive impairment: current concepts and clinical developments. Lancet Neurol 2008, 7:246-55.
• [3]Makin SDJ, Turpin S, Dennis MS, Wardlaw JM: Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry 2013, 84:893-900.
• [4]Jacova C, Pearce LA, Costello R, McClure LA, Holliday SL, Hart RG, et al.: Cognitive impairment in lacunar strokes: the SPS3 trial. Ann Neurol 2012, 72:351-62.
• [5]Blanco-Rojas L, Arboix A, Canovas D, Grau-Olivares M, Oliva Morera JC, Parra O: Cognitive profile in patients with a first-ever lacunar infarct with and without silent lacunes: a comparative study. BMC Neurol 2013, 13:203. BioMed Central Full Text
• [6]Brookes RL, Willis TA, Patel B, Morris RG, Markus HS: Depressive symptoms as a predictor of quality of life in cerebral small vessel disease, acting independently of disability; a study in both sporadic small vessel disease and CADASIL. Int J Stroke 2013, 8:510-7.
• [7]Folstein MF, Folstein SE, McHugh PR: “Mini mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12:189-98.
• [8]O’Sullivan M, Morris RG, Markus HS: Brief cognitive assessment for patients with cerebral small vessel disease. J Neurol Neurosurg Psychiatry 2005, 76:1140-5.
• [9]Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al.: National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006, 37:2220-41.
• [10]Brookes RL, Hannesdottir K, Lawrence R, Morris RG, Markus HS: Brief Memory and Executive Test: evaluation of a new screening test for cognitive impairment due to small vessel disease. Age Ageing 2012, 41:212-8.
• [11]Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al.: The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005, 53:695-9.
• [12]Gunning-Dixon FM, Raz N: Neuroanatomical correlates of selected executive functions in middle-aged and older adults: a prospective MRI study. Neuropsychologia 2003, 41:1929-41.
• [13]Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA: MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging deficiency. AJR Am J Roentgenol 1987, 149:351-6.
• [14]Stroke Research Group Cambridge University. BMET Cognitive Testing. http://www.cambridgestroke.com/bmetcognitivetesting.php.
• [15]Nelson HE: National Adult Reading Test. Windsor, UK, NFER-Nelson; 1982.
• [16]Petersen RC: Mild cognitive impairment as a diagnostic entity. In J Intern Med Volume 2004, 256:183-94.
• [17]StataCorp. 13. Stata: Release 13. College Station, TX: StataCorp LP; 2013.
• [18]De Koning I, Dippel DW, Van Kooten F, Koudstaal PJ: A short screening instrument for poststroke dementia: the R-CAMCOG. Stroke 2000, 31:1502-8.
• [19]Torralva T, Roca M, Gleichgerrcht E, López P, Manes F: INECO Frontal Screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol Soc 2009, 15:777-86.
• [20]Price CC, Jefferson AL, Merino JG, Heilman KM, Libon DJ: Subcortical vascular dementia: integrating neuropsychological and neuroradiologic data. Neurology 2005, 65:376-82.
• [21]Duering M, Gesierich B, Seiler S, Pirpamer L, Gonik M, Hofer E, et al.: Strategic white matter tracts for processing speed deficits in age-related small vessel disease. Neurology 2014, 82:1946-50.
• [22]Dichgans M, Markus HS, Salloway S, Verkkoniemi A, Moline M, Wang Q, et al.: Donepezil in patients with subcortical vascular cognitive impairment: a randomised double-blind trial in CADASIL. Lancet Neurol 2008, 7:310-8.
• [23]Arboix A, Font A, Garro C, García-Eroles L, Comes E, Massons J: Recurrent lacunar infarction following a previous lacunar stroke: a clinical study of 122 patients. J Neurol Neurosurg Psychiatry 2007, 78:1392-4.