Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 53, Issue 4 M281-M286, Copyright © 1998 by The Gerontological Society of America
The time and change test: a simple screening test for dementia
SK Inouye, JT Robison, TE Froehlich and ED Richardson
Department of Internal Medicine, Yale School of Medicine.
BACKGROUND: Although dementia screening tests are available, they have not
gained widespread use in hospital or primary care settings. Our goal was
to develop a simple, standardized, performance-based test incorporating
real-world activities to augment screening efforts in older populations:
the Time and Change (T&C) Test. METHODS: The study followed a
prospective cohort design, involving medicine and surgery services at an
urban teaching hospital. From consecutive admissions, 776 participants
aged 70-98 years, 14% with dementia, were enrolled. T&C ratings were
validated against a reference standard based on the modified Blessed
Dementia Rating Scale and the Mini-Mental State Examination (MMSE).
Convergent validity with other cognitive measures, test-retest agreement,
and interobserver reliability were assessed. RESULTS: The T&C Test had
a sensitivity of 86%, specificity of 71%, and negative predictive value of
97%. The T&C Test demonstrated convergent agreement with 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
seconds to complete and was acceptable to participants. Refusal of any
test component occurred in 39 individuals (5%). CONCLUSIONS: The T&C
Test is a simple, accurate, reliable, performance-based tool for detection
of dementia. With its quick, easy-to-use, real-world nature, we hope the
T&C Test will be used for widespread cognitive screening in older
populations.
