Memory disorders: senile insanity, senile dementia, dementia

Early diagnosis of dementia is extremely important, because timely detection of pathology will prevent its further development and effectively provide treatment. However, detecting symptoms of dementia in the early stages of the disease is very difficult. Dementia detection tests are one of the most reliable and simplest ways to detect pathology. Based on the results of a person’s performance of certain test tasks, one can judge whether he has certain disorders characteristic of dementia, and the need for more serious examination methods.

Classification of diagnostic tests

Dementia can be detected by performing the following types of tests:

1. Assessment of a person’s ability to navigate space, time and his personality.
2. Testing different types of memory: short-term and long-term (the ability to remember events that happened recently and what happened many years ago).
3. The ability to perform purposeful actions (praxis) is assessed. For example, can a person light matches, etc.
4. Visual-spatial functions are tested by drawing various geometric shapes, etc.
5. Assessing the patient’s own speech and his ability to perceive someone else’s.
6. The patient's ability to remember the purpose of various objects that are shown to him is tested.
7. Tests to assess the level of intelligence.

Many tests to check for dementia can be administered to the patient at home, either by themselves or with the help of relatives. However, most often they are used by a neurologist when examining a person for the early detection of dementia.

SAGE test

The SAGE (Self-Administrated Gerocognitive Exam) test, aimed at detecting minor disorders of memory, thinking and the first signs of dementia, was developed by US scientists. In clinical trials, it has been shown to be highly sensitive with a low likelihood of misdiagnosis. The main advantage of this test is that you can take it yourself, without the involvement of a specialist, which helps to easily identify early signs of dementia.

Running the test

The Sage test for dementia involves the person performing certain tasks themselves using a pen or pencil. The health care professional or loved one of the patient should ensure that the person being tested does not use a calendar or watch. In cases where a person has difficulty completing a task and asks for help, the subject should be asked to do as many exercises as possible.

It usually takes 10-15 minutes to complete the test, but the time can be increased on an individual basis. Four alternative versions of the SAGE test have been developed, but the most common set of exercises is described below.

Test items, scores and interpretation

The completion of each test task is assessed by a certain number of points, which are summed up at the end and a conclusion is drawn about the patient’s condition.

1. Orientation. The patient is asked to name today's date (day, month and year of the test) without using a clock, calendar or other cues.
2. Names of items. The person must name the objects shown in the picture (rhinoceros and harp).
3. Search for similarities. The patient must answer the question: what is common between two objects (a rose and a tulip).
4. Computing. It is necessary to calculate how many fifty dollars are in three rubles.
5. Computing. A person must calculate how much change they will give him from five rubles if the purchase amount is 3 rubles and 5 kopecks.
6. Memory. The patient must complete this task at the very end, when all other exercises have been completed. At the bottom line on the last page of the test you need to write the phrase: “I finished.”
7. Drawing a 3D figure. A person must copy the depicted drawing, composed of geometric shapes.
8. Drawing a clock. It is necessary to draw a dial and numbers on it, and then position the clock hands so that the time shown corresponds to the indicated time - 10 minutes to 11 hours. After this, the patient needs to write the letter “D” next to the long minute hand, and “K” next to the short one. This test is one of the most popular ways to test for dementia.
9. Assessing a person's vocabulary. The patient must write twelve names of different countries.
10. Sequencing. The subject needs to draw a line between the circles, inside which numbers and letters are written, alternating numerical and alphabetic symbols (end with “E”).
11. Transformation task. The presented figure shows four triangles built from lines. It is necessary to remove (cross out) 2 of them so that you end up with three triangles. At the end, the patient needs to draw the resulting figure.
12. Memory. The person must remember the phrase from task 6 and write it down correctly. Memory impairment is one of the main criteria for dementia.

Calculation of points received during the test

Exercise	Maximum points	Estimated parameter	Points for answer
1. Orientation in time and space	4	date	The correct answer is 2; approximately correct answer (with a difference of no more than 3 days) – 1; another answer is 0.
		Month	The correct answer is 1; incorrect answer – 0.
		Year	The correct answer is 1; incorrect answer – 0.
2. Names of objects	2	Identification of each object depicted (spelling errors are not taken into account)	True – 1; incorrect – 0.
3. Search for similarities and differences	2	Found similar sign	Abstract categorical parameter – 2; similarity of appearance – 1; other – 0.
4. Account	1	The resulting number	The correct answer is 1; incorrect – 0.
5. Account	1	Change amount	The correct answer is 1; incorrect – 0.
6. Memory test	Points for the exercise are awarded in the 12th task.
7. Drawing a 3D image.	2	Shape of the figure, parallelism of lines and their deviation	The figure is depicted correctly, of the desired shape, the lines are parallel and deviate within 10 degrees - 2; an image of a different shape or its lines are not parallel, the deviation is more than 10 degrees – 1; other – 0.
8. Clock drawing test	2	Clock face	4 correctly completed points – 2; 3 out of 4 – 1; other – 0.
		Numbers (correct order and approximately correct position)
		Arrangement of hands (show the correct time and start from the center)
		Dimensions of arrows and their letter designation
9. Vocabulary assessment	2	Number of correct answers	12 correct answers – 2; 10-11 – 1; less than 10 – 0.
10. Sequencing Test	2	The number of errors when connecting two elements incorrectly is estimated	No errors - 2; 1 or 2 – 1; more than 2 – 0.
11. Transformation task	2	The choice of the necessary lines and the image of the final figure are evaluated	The necessary lines are crossed out and the final figure is depicted correctly - 2; the lines are chosen correctly, but the final shape is depicted incorrectly or not drawn at all – 1; lines are not marked, but the final figure is depicted correctly - 1; other – 0.
12. Memory	2	Phrase accuracy	The phrase is accurately written without unnecessary words - 2; the phrase is written inaccurately, but there is the word “finished” - 1; other – 0.

This dementia test is interpreted based on the total score:

• 17 - 22 - it is most likely that a person’s memory and mental activity corresponds to the norm;
• 15 - 16 - with a high degree of probability, the person taking the test has moderate memory and thinking disorders (it is recommended to consult a specialist);
• 14 or less - most likely the patient has severe thinking and memory impairments, which requires consultation with a specialist doctor.

Important! Diagnosing dementia with tests does not replace other examination methods!

Based on the results of the SAGE test, one can judge whether a person requires additional diagnostic measures to identify disorders accompanied by dementia or not.

Clock test

The dementia watch test is widely known, quite simple and informative, so it can be successfully used for the early detection of dementia. The person is given a blank piece of paper and a pencil, asked to draw a clock with a round dial and numbers on it, and also use the arrows to indicate the desired time (usually fifteen minutes to two).

The patient cannot use any hints, but must complete the task absolutely independently. The dementia clock test is assessed on a ten-point scale:

• 10 points correspond to the norm: a circle is depicted, the numbers are located correctly, and the arrows point to the numbers corresponding to the given time;
• 9 points if there are slight deviations in the position of the clock hands;
• 8 - significant deviations in the location of the arrows (one arrow is mistaken by more than one digit);
• 7 – large and small arrows are positioned incorrectly;
• 6 - arrows do not indicate time at all;
• 5 - numbers in the circle are arranged in reverse order or at different distances;
• 4 – the clock is not complete, since some numbers are missing, or they are located outside the circle;
• 3 — the clock face and numbers are not interconnected;
• 2 - a person tries to do a task to pass the test, but without any success;
• 1 - the subject does not try to do the exercise.

A test result of less than 9 points indicates severe impairments in memory and thinking. To clarify the diagnosis, a clock drawing test is performed to determine the degree of dementia, which is a simplified version of the exercise. In this case, the patient is given the task of drawing arrows indicating the desired time, already on the depicted dial with numbers. The severity of dementia is judged by the ability and quality of the task.

TMT (Trail Making Test) - path laying test

One of the tests for determining frontal dysfunction and, accordingly, identifying damage to executive functions is the Trail Making Test. It is advisable to perform it in those patients who do not have motor impairments, can sit freely without pain, and are able to concentrate on a written task.

TMT consists of two parts: A and B.

Scheme for part A: The task is to connect all the numbers with each other as quickly as possible, without lifting the pen from the sheet. In this case, time is recorded.

If done correctly, the lines should not intersect with each other. Part A, consisting of numbered circles from 1 to 25, is simpler than Part B.

Montreal Cognitive Assessment (MoCa)

This is a scale for determining the level of cognitive functions, used by specialists in everyday work. The Montreal Dementia Test consists of 30 questions, takes about 10-12 minutes and allows you to characterize the subject's:

• attention (repeat different sequences of numbers in forward and reverse order) and the ability to concentrate on something;
• executive functions (draw a line with the correct alternation of numbers and letters);
• memory (the ability to repeat five words spoken by the tester at different times);
• speech (correctly repeat two heard sentences and then name words starting with a specific letter);
• visual-constructive abilities (draw the shape of a cube);
• abstract thinking (during the test the patient must explain how two objects are similar);
• ability to calculate and count;
• orientation (asked to name today's date).

Important! Most dementia tests are comprehensive and measure multiple brain functions at once!

Also included in the Montreal Dementia Test are exercises for naming pictured animals and drawing a clock.

A test score of 26 to 30 (maximum) is the norm. If the result is less, then the person being studied has cognitive impairment to some degree.

Speech activity test

In order to conduct a speech activity test, the subject is asked to name as many names of plants or animals and words starting with a certain letter, for example “l”, in 1 minute. Normally, in one minute, most older people with secondary and higher education name from 15 to 22 plants and from 12 to 16 words starting with a certain letter. If the number of named plants or animals and words starting with a certain letter is less than 10, this is a sign of fairly severe memory impairment.

Here are some tips for people experiencing memory loss in their elderly relatives:

• Create a favorable environment in the family, because positive emotions help stop the disease process, just like medications.
• When talking, limit your exposure to distracting noise. Before you speak, address the person by name.
• When speaking, try to use simple words and sentences. If you were not understood the first time, repeat in a calm voice.
• If your relative is upset or tired, redirect his attention, for example, go for a walk with him.
• Try to remember old times as often as possible, ask to talk about your childhood and youth. In the process of dementia, short-term memory (for current events) suffers, but memory for the past is preserved.
• Remember that there are people next to you who once took care of you when you were completely helpless, helped you, gave you their love, now they themselves are faced with problems and only you can help them cope with this.

Mini-Cog

The Mini-Cog test is a simple way to detect dementia, takes only 3-5 minutes and has a high probability. The method will help assess the patient's short-term memory and visual-spatial coordination.

Here's how to test for dementia in older adults:

1. The subject is told three words and asked to remember them.
2. Afterwards, the person is asked to draw a watch dial in the shape of a circle, put numbers on it and indicate the given time using the arrows.
3. At the end of the test, the person is asked to remember and repeat three words from the first task.

Each named word is worth 1 point. Three points indicate the absence of dementia, and zero confirms its presence in the subject. One or two points require moving on to the second test item. If it is performed without errors, then there is no dementia. In other cases, the degree of violations is assessed in accordance with the “clock test” scoring system.

MIS Memory Assessment

The first signs of impending dementia may be memory loss. To test the ability to remember information and retain it, a short MIS (Memory Impairment Screen) test is used.

The subject is asked to remember 4 words from 4 different categories. For example:

• From the “construction” category – the word “-“history”.
• “City workers” – “policeman”.
• “Personal hygiene” – “towel”.

The patient is asked to repeat these words out loud and is warned that they will be asked to repeat them later. Then they go directly to the test.

MIS Memory Test Questions:

1. In 30 seconds, name the maximum possible number of animals.
2. In the next 30 s, if more than 4 animals were named, it is proposed to add to the list. If less than 4 animals were named in the first 30 seconds, they give a hint, reminding them of animals on a farm or in a zoo, and offer to continue naming the animals.
3. You are given 20 seconds to remember the 4 words suggested at the beginning of the test, and then asked to repeat them.
4. For words that the subject could not remember, a hint is given (it is indicated which category the word is from). The answer is given 5 s.

Test Assessment

To evaluate the result, the number of words that the patient was able to remember in step 3 is multiplied by 2 and the number of words that were remembered when the category was recalled is added to the result.

The maximum MIS test score is 8. If the score is less than 6, the patient is offered an additional detailed examination.

See also our detailed article about the stages of dementia, it talks about the features of the course of the disease at each stage and options for solving possible problems.

MMSE scale

The MMSE (Mini-Mental State Examination) mental state scale allows you to identify probable cognitive disorders. This test for senile dementia is used by neurologists for any suspicion of pathology.

The test includes 9 different samples, ranging from simple to more difficult and characterizing:

• orientation in time;
• orientation in space;
• perception;
• ability to concentrate;
• speech (assessment using various methods).

This multiple-question dementia test has a maximum score of 30 points. If a person scores 25-30 points, then there is no pathology. A lower result indicates the presence of cognitive disorders of varying severity. A score of less than 10 points is typical for patients with severe dementia.