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Brief Memory and Executive Test is an effective screen for vascular dementia

Clinical Question:
How accurate is the Brief Memory and Executive Test in screening patients for vascular dementia?

Bottom Line:
In this derivation study, the Brief Memory and Executive Test (BMET) was simple to administer, reasonably accurate, and better than the Mini-Mental State Examination (MMSE) in identifying patients with vascular dementia. The test needs independent validation to see if it performs as well in the real world. I am not sure how I would use this in practice, however, as I am unaware of differences in the management of patients with Alzheimer's disease and those with vascular dementia. (LOE = 3b)

Reference:
Brookes RL, Hannesdottir K, Lawrence R, Morris RG, Markus HS. Brief Memory and Executive Test: evaluation of a new screening test for cognitive impairment due to small vessel disease. Age Ageing 2012;41(2):212-218.  [PMID:22267862]

Study Design:
Cohort (prospective)

Funding:
Government

Setting:
Outpatient (specialty)

Synopsis:
These researchers administered the BMET, the MMSE, and the clinical dementia rating scale to a cadre of elderly patients previously diagnosed with vascular dementia (n = 45) or Alzheimer's disease (n = 27), and to a group of healthy control patients (n = 80). The BMET assesses executive functioning (sequencing: motor, letter, number-letter switching) and processing speed (letter-number matching). Each element of the BMET was designed to be quick and easily administered using paper forms. The test took approximately 10 minutes to complete. The authors don't mention if the tests were administered by personnel masked to the patients' underlying diagnoses. Using the patients' established diagnosis as the gold standard, the BMET correctly identified two thirds of the patients with vascular dementia and more than half (58%) of the patients with Alzheimer's disease; the MMSE correctly identified one fourth of the patients with vascular dementia and two thirds of patients with Alzheimer's disease. Overall, the BMET was 91% sensitive and 85% specific in distinguishing vascular dementia from Alzheimer's disease in patients with cognitive impairment (positive likelihood ratio [LR+] = 6.1; negative likelihood ratio [LR-] = 0.1); the MMSE was 63% sensitive and 62% specific (LR+ = 1.7; LR- = 0.6). Since this is a derivation study, it needs independent verification to see if it works in unselected populations.

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