THE TIME AND CHANGE TEST - A SIMPLE SCREENING-TEST FOR DEMENTIA

Background, Although dementia screening tests are available, they have not gained widespread use in hospital or primary care settings. Our g oal was to develop a simple, standardized, performance-based test inco rporating real-world activities to augment screening efforts in older populations: the Time and Change (T&C) Test. Methods. The study follow ed a prospective cohort design, involving medicine and surgery service s at an urban teaching hospital. From consecutive admissions,: 776 par ticipants aged 70-98 years, 14% with dementia, were enrolled. T&C rati ngs were validated against a reference standard based on the modified Blessed Dementia Raring Scale and the Mini-Mental Stare Examination (M MSE). Convergent validity with other cognitive measures, test-retest a greement, and interobserver reliability were assessed. Results. The T& C Test had a sensitivity of 86%. specificity of 71%, and negative pred ictive value of 97%. The T&C Test demonstrated convergent agreement wi th three cognitive measures, agreeing most strongly with the MMSE (r = .58). Test-retest and interobserver agreement rates were 88% and 78%, respectively. Education explained 3% of the variance of the T&C Test, compared with 13% of the MMSE. The T&C Test took a mean of 22.9 second s to complete and was acceptable to participants. Refusal of any test component occurred in 39 individuals (5%). Conclusions. The T&C Test i s a simple, accurate, reliable, performance-based tool for detection o f dementia. With its quick, easy-to-use, real-world nature, we hope th e T&C Test will be used for widespread cognitive screening in older po pulations.