22 (3.5%) did not finished the study 5 No consent 5 Sensitive-motor deficit

1. Usefulness of the Money Test for detection of Cognitive Impairment A Frank*, C Carnero**, A Tallón*, A García*, MS Barquero***, JL Dobato, J Ferrero, J Díaz, A Pérez, S Mola, J Morera, on behalf the “Money Test Group”. H. La Paz, Madrid; H. Torrecárdenas, Almería; H. Clínico San Carlos, Madrid; Spain Severe D. 2,5% Moderate D. 35 2 37 11,7% Mild D. 212 60 63 105 16,5% Noimpairment 53,5% 50 Methods The following parameters were calculated by standard statistical methods: sensibility (S), specificity (Sp), predictive value (PV) and area under the ROC curve (AUR), each with each its own 95% confidence intervals. Concurrent validity was calculated by Spearmans correlation coefficient (r). In a sample of 47 subjects test-retest reliability was analyzed using the interclass correlation reliability coeficient (ICC). MCI Results Data from 570 subjects were analyzed (Figure 1). Of the whole series, 56 subjects were excluded because the protocol was incompleted. The number of subjects classified in each group was: 305 NCI and 265 CI (90 MCI, 175 DEM). 8% of the sample was illeterate and 45% had <5 years of schooling. The best MT cut-point shows S=0.87(0.82-0.91); Sp=0.84(0.8-0.88); positive PV=0.83(0.78-0.89); negative PV=0.88(0.84-0.92) and AUR=0.91(0.89-0.93). MT has a high concurrent validity: MMSE (r=0.8); MEC (r=0.79), VFT (r=0.74), as well as excellent test-retest reliability (ICC=0.92). Results in this series show MT to have either a higher validity or reliability than other frequently employed tests. MMSE = 302 15,8% Conclusions MT has a high discriminative validity for cognitive impairment detection and appears to be more reliable than other frequently used instruments. It is also ecological and has content validity. An important additional advantage is that it is easy to appliy, quick and can be used in uneducated persons. All these properties together with the possibility of adapting the test to different environments, cultures and currency systems, make the MT a useful international instrument for the detection of cognitive impairment. Background MT is an easy, short (< 5 minutes), ecological test (it uses common currency) and is well accepted by study populations independently of their educational level. Its factorial structure allows the evaluation of several independent cognitive domains. These characteristics suggest that MT would be a good instrument for cognitive impairment detection, mainly in poorly-educated populations in which other frequently-used tests do not seem to be effective enough. 40 MEC = 207 Other Dementias 30 7,5% 56 Fluency = 436 20 72 Frecuencia Enf. Alzheimer MT = 570 10 22,5% 0 ,00 5,00 10,00 15,00 20,00 25,00 TOTAL No Dementia 70,0% 2/3/73 1/1/28 Figure1: Participant subjects Tests 2/3/75 30 3/3/77 • 498 (87%) underwent at least one short test • 302 MMSE • 207 MEC • 436 Animal Fluency • 63 (11%): Three tests • 321 (56%): Two tests • 114: (20%): One test 19 Centers 25 Neurologists 625 selected subjects (570) 20 Objective To analyze the usefulness of the “Money Test” (MT) to detect cognitive impairment in a general neurological practice. 10 • 22 (3.5%) did not finished the study • 5 No consent • 5 Sensitive-motor deficit • 9 Advanced cognitive impairment • 3 Other reasons • 34 subject (5.44%) no considered because incomplete data TOTAL 0 Money Test Group N = 305 265 2/3/77 No Yes 4/6/152 Cognitive Impairment 5/10/357 Design Multicentric, transversal study of 635 subjects aged > 60 years. MT was applied in addition to other tests, such as the Mini-mental state examination (MMSE), the Spanish version of MMSE (MEC) and the verbal fluency test (VFT). Independently of the results of these tests, the sample population was classified by an independent neurologist as “Not cognitively impaired” (NCI) or “Cognitively Impaired” (CI) and the latter group was subdivided into two subgroups: “Mild Cognitive Impairment” (MCI) or “Dementia” (DEM). Criteria validity with other tests (Best cut point) COMPARATION MT: discriminative validity Point S E VPP VPN CC Test N Punt S E CC  19 0.75 0.93 0.91 0.81 0.85 MT 570  21 0.87 0.84 0.86  20 0.81 0.89 0.87 0.85 0.86 MMSE 302  23 0.7 0.89 0.79  21 0.87 0.84 0.83 0.88 0.86 MEC 207  29 0.84 0.76 0.81  22 0.91 0.76 0.77 0.91 0.83  23 0.95 0.66 0.71 0.93 0.79 Fluency 436  10 0.65 0.88 0.76 S E VPP VPN H.Universitario La Paz – Madrid Anna Frank García Antonio Tallón Barranco Ángel García González H.Universitario La Fe – Valencia Miguel Baquero Toledo Anabel Campos H.Gómez Ulla – Madrid Julio Ferrero Arias Clínica San Rafael - Cádiz Pedro A. Sánchez Ayaso H.Virgen de la Macarena - Sevilla Carlos Martínez Parra José Manuel Gata Gata H.Vega Baja - Orihuela Ángel Pérez Sempere Santiago Mola Caballero de Rodas Fundación Hospital Alcorcón José Luis Dobato Ayuso H. Ntra.Sra. Aranzazu - San Sebastián Begoña Indakoetxea Juanbeltz H. Virgen de las Nieves - Granada Rosa Vilches Carrillo H. Virgen del Camino - Pamplona José M. Manubens Bertrán H. Clínico San Carlos - Madrid María S. Barquero Jiménez María A. Payno Vargas H. General Universitario - Murcia Mª Luisa Martínez Navarro H. Río Carrión - Palencia Valentín Bueno Rodríguez H. Marina Alta - Denia Jaume Morera Guitart H. 12 de Octubre - Madrid Jaime Díaz Guzmán H. Torrecárdenas – Almería Cristóbal Carnero Pardo* Elena Márquez Báez Teresa García López Pedro Guardado Santervás Jesús Olivares Romero Pedro Serrano Castro Teresa Montoro Ríos H. General Yagüe – Burgos Miguel Góñi Imízcoz Sara Merino H.Virgen de la Arrixaca – Murcia Carmen Antúnez Almagro Rafael Carles Díez H. de Navarra – Pamplona Francisco Lacruz Bescos Isabel Aramendia Etxeberria H.Cruz Roja Española – Córdoba Antonio Arjona Padillo  21 0.87 0.84 0.83 0.88 Spearman´s Correlation Coeficient Concurrent Validity IC95% L.I. 0.82 0.8 0.78 0.84 L.S. 0.91 0.88 0.89 0.92 MMSE MEC Fluency MT 80 MMSE 1 .95* .68* .80* MEC n = 65 1 .72* .79* Compared Criteria Validity ROC curves Demographics Clinical characteristics Fluency n = 275 n = 170 1 .74* 60 MT n = 302 n = 207 n = 436 1 PRUEBA N ÁREA e.e. LI LS • Age: 72.7  6.8 years • Sex: 310 Women (54.5%) • Procedence: 370 (65%) urbans (>30.000 inhabitants) • Educational level: • 13% Never went to school • 45% Primary studies • Alphabetization: • 8% illeterate • 28% can read 40 • 62% had another process which could lead to cognitive impairment • Cognitive Diagnosis: • 305 No cognitive impairment (53.5%) • 90 Mild cognitive impairment (15.8%) • 175 Dementia (30.7%) • Mild: 94 (53.7%) • Moderate: 67 (38.3%) • Severe: 14 (8%) • 128 Alzheimer ´s disease(73% out of the whole dementias) * p < 0.0001 MT 570 0.91 0.01 0.89 0.94 MMSE 302 0.88 0.02 0.84 0.92 20 Test-Retest Feasibility MEC 207 0.89 0.02 0.84 0.93 Fluency 436 0.81 0.02 0.77 0.85 N CCI IC 95% 0 61 65 69 73 77 81 85 89 93 97 100 100 MT 47 0.92 0.86 – 0.96 80 80 *Actualmente en el Hospital Virgen de las Nieves (Granada, Spain)e-mail: ccarnerop@supercable.es Not avalilable Universitaries 4% 60 60 MEC 45 0.87 0.77 – 0.93 5,8% Never went to school Secundaries 40 40 TFV 44 0.75 0.59 – 0.86 12,6% 9,6% Sensibility 20 20 Primary Studies 0 0 0 20 40 60 80 100 0 20 40 60 80 100 Primary Incomplete 26,1% 1-Specificity 1- 45,4% P04-034 Acknowledgment Partially supported by SAS (Exp. 230/00)