22 (3.5%) did not finished the study

5 No consent5 Sensitive-motor deficit9 Advanced cognitive impairment3 Other reasons

34 subject (5.44%) no considered because incomplete data

Figure1:Participant subjects

1/1/28 2/3/73

2/3/75

4/6/152

3/3/77

2/3/77

5/10/357

19 Centers25 Neurologists625 selected subjects (570)

Acknowledgment

Partially supported by SAS (Exp. 230/00)

Tests• 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

2

63 105212

3735

56

72Fluency = 436

MT = 570

MMSE = 302

MEC = 207

Demographics• 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

97938985817773696561

80

60

40

20

0

5,8%

9,6%

26,1%

45,4%

12,6%

4%Universitaries

Secundaries

Primary StudiesPrimary Incomplete

Never went to school

Not avalilable

2,5%

11,7%

16,5%

15,8%

53,5%

Severe D.

Moderate D.

Mild D.

MCI

Noimpairment

7,5%

22,5%

70,0%

Other Dementias

Enf. Alzheimer

No Dementia

Clinical characteristics

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)

MT: discriminative validity

0.79

0.83

0.86

0.86

0.85

CC

0.930.710.660.95 23

0.910.770.760.91 22

0.880.830.840.87 21

0.850.870.890.81 20

0.810.910.930.75 19

VPNVPPESPoint

L.S.

L.I.

0.920.890.880.91

0.840.780.80.82IC95%

0.880.830.840.87 21

VPNVPPES

Criteria validity with other tests (Best cut point)

0.76

0.81

0.79

0.86

CC

0.880.65 10436Fluency

0.760.84 29207MEC

0.890.7 23302MMSE

0.840.87 21570MT

ESPuntNTest

Compared Criteria Validity ROC curves

Fluency

MEC

MMSE

0.940.890.010.91570MT

LSLIe.e.ÁREANPRUEBA

0.850.770.020.81436

0.930.840.020.89207

0.920.840.020.88302

1-100806040200

100

80

60

40

20

0

1-Specificity100806040200

Se

nsi

bili

ty

100

80

60

40

20

0

Concurrent Validity

n = 302

n = 275

n = 65

1

MMSE

1n = 436n = 207MT

.74*1n = 170Fluency

.79*.72*1MEC

.80*.68*.95*MMSE

MTFluencyMEC

Spearman´s Correlation Coeficient

* p < 0.0001

Test-Retest Feasibility

44

45

47

N

0.59 – 0.860.75TFV

0.77 – 0.930.87MEC

0.86 – 0.960.92MT

IC 95%CCI

TOTAL

25,0020,0015,0010,005,00,00

Fre

cuen

cia

60

50

40

30

20

10

0265305N =

Cognitive ImpairmentYesNo

TO

TA

L

30

20

10

0

COMPARATION

Usefulness of the Money Test for detection of Cognitive ImpairmentUsefulness of the Money Test for detection of Cognitive ImpairmentA 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

P04-034

Objective

To analyze the usefulness of the “Money Test” (MT) to detect cognitive impairment in a general neurological practice.

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).

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).

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.

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.

H. Torrecárdenas – AlmeríaCristóbal Carnero Pardo*Elena Márquez Báez Teresa García LópezPedro Guardado SantervásJesús Olivares RomeroPedro Serrano CastroTeresa Montoro Ríos

H. General Yagüe – BurgosMiguel Góñi ImízcozSara Merino

H.Virgen de la Arrixaca – MurciaCarmen Antúnez AlmagroRafael Carles Díez

H. de Navarra – PamplonaFrancisco Lacruz BescosIsabel Aramendia Etxeberria

H.Cruz Roja Española – CórdobaAntonio Arjona Padillo

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

*Actualmente en el Hospital Virgen de las Nieves (Granada, Spain)e-mail: ccarnerop@supercable.es

Money Test Group

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.