As we get older and more forgetful, most of us have wondered at one time or another if we are candidates for Alzheimer disease. It has been claimed that there are up to 125 undiagnosed Alzheimer patients in a typical US primary care practice. Now that newer treatments are raising hopes that the condition can be relieved, it is important that this distressing condition is diagnosed swiftly and correctly. Unfortunately, the memory status tests used at present are time-consuming and not always as accurate as they should be. To ease this problem, two scientists from the University of Vermont have developed a 7-minute test to diagnose Alzheimer disease; they have tested its reliability by comparing results in patients with Alzheimer disease against those from age- and education-matched normal older persons ¹.

The 7 Minute Screen consists of 4 sets of questions that focus on orientation, memory, visuospatial skills and expressive language. These are the areas most likely to reveal deficiencies in Alzheimer disease.

Orientation is tested by asking the subject to identify the present month, date, year, day of the week and time of day. The degree of error is graded, so that a one-day error in date is scored as one, while a one-month error is scored as 5 errors.

To test memory, subjects are asked to identify 16 items drawn on 4 cards, with the help of a clue or hint from the tester (e.g. theres a piece of fruit on this page what is it?). After successful identification, the card is hidden and the subject asked to recall the item after being given the clue again. After all 4 cards have been completed, the subject is distracted by having him/her recite the months of the year backwards. The subject is then asked to recall as many of the 16 items as possible, without any hints.

Visuospatial skills involve transforming 2 dimensional visual images into movement. This ability is measured by having the subject draw a clock face, with the hands drawn at 20 minutes before 4 oclock. Scoring is based on the correctness of the drawing (e.g. the hour hand should be shorter than the minute hand). To test expressive language, or verbal fluency, the subject is asked to name as many animals as possible within 1 minute.

Health professionals administered the 7 Minute Screen to 60 normal elderly individuals without a history of brain disease or head injury. Half of them also had more complex standard mental tests. The 7 Minute Screen was also given to 60 Alzheimer patients referred to the clinic who met strict diagnostic criteria for the disease.

There were no differences in age, level of education and gender distribution between the two groups heathy normals and Alzheimer disease patients. The average age was 77½, with two women to every one man.

The patients with Alzheimer disease had significantly worse scores on each of the 4 tests in the 7 Minute Screen. The screen correctly diagnosed 92% of the Alzheimer patients and 96% of the normal subjects. When only patients with mild Alzheimer disease (based on one of the standard diagnostic tests) were included in the analysis, the screen correctly diagnosed 98% of the Alzheimer patients and 98% of the normal elderly subjects.

The reliability of the 7 Minute Screen was tested by re-administering it to 25 subjects from each group, 1-2 months after the first screening. Two raters scored the same session for a similar sample size, to test for inter-rater reliability. By both methods, reliability was shown to be high. However, the superiority of the 7 Minute Screen over standard tests remains to be established, for example in different languages or cultural settings.

The scientists who designed and tested the 7 Minute Screen have shown that it can diagnose Alzheimer disease correctly and more reliably than the much more extensive standard tests. However, further testing may well show that the screen cannot distinguish Alzheimer disease from other types of dementia, or clinical depression.

It seems likely that the 7 Minute Screen, which can be administered by health professionals after only minimal training, will prove useful in health care settings where there are often severe time and cost limits. Nevertheless, although it is fast and easy, we must remember it is only a screening test, and cannot replace a physicians careful, personal assessment of the patients mental condition.