Tools for Alzheimer's Screening: BrainCheck

Screening for cognitive decline and early Alzheimer's disease presents a clinical challenge for primary care providers.

A variety of tests and tools are available for use but limited research has focused on testing in primary care settings.

Michael Ehrensperger and colleagues recently published a study of a brief tool for screening for cognitive decline called BrainCheck.

This tool combines a patient interview, an informant interview and the Clock Drawing Test administered in combination.

The importance of this tool is that it has been studied in a feasibility and validation study design with 52 general practitioners in Switzerland and in a specialized Memory Clinic.

The key elements of the design include the following:

• BrainCheck Tool: Five item patient interview, clock drawing test rated on a five point scale and a seven item informant interview.
• Feasibility study: 52 general practitioners employed the tool in a primary care setting and rated patient acceptance, understanding and global feedback on their experience
• Validity study: 288 Memory Clinic patients with mild cognitve impairment, Alzheimer's disease or major depression completed BrainCheck. 126 cognitively healthy controls also completed the screen

The findings from the study included:

• General practitioners rated BrainCheck as highly feasible and accepted in the primary care setting
• The tool performed well on classifying Memory Clinic patients and controls-correct classification rate 81.2%, sensitivity=83%, specificity 79.4%
• Using a post-hoc decision analysis approach improved the correct classification rate to 89.4% with sensitivity of 97.3% and specificity of 81.4%

The authors conclude that the BrainCheck tool is a rapid (3 minute) test that is feasible and acceptable for primary care. It produces a recommendation for either referral for specialist assessment or a watchful waiting approach.

A primary weakness of the current study is that the tool validity assessment was not done in the primary care population and further validity testing in this setting will be needed.

The Clock Drawing Test is a commonly used test for cognitive impairment screening and should be familiar to primary care providers caring for elderly subjects. More information about the Clock Drawing Test from the University of Iowa can be found here.

Readers with more interest in the Swiss study manuscript on BrainCheck can be access the free full-text manuscript by clicking on the PMID link below.

Clock Drawing Test figure simulating cognitive impairment is from the author's files.

Follow the author on Twitter WRY999.

Ehrensperger MM, Taylor KI, Berres M, Foldi NS, Dellenbach M, Bopp I, Gold G, von Gunten A, Inglin D, Müri R, Rüegger B, Kressig RW, & Monsch AU (2014). BrainCheck - a very brief tool to detect incipient cognitive decline: optimized case-finding combining patient- and informant-based data. Alzheimer's research & therapy, 6 (9) PMID: 25422675