Test Your Memory test: diagnostic utility in a memory clinic population

Background: Test Your Memory (TYM) test is a recently described cognitive test instrument designed to be self-administered under medical supervision. The pragmatic role of such self-administered tests in cognitive clinics has not previously been examined. We investigated the diagnostic utility of the TYM as an independent test to differentiate patients with and without dementia at initial clinical diagnostic interview in dedicated memory clinics. Methods: TYM was administered to consecutive new patient referrals to two memory clinics independent of other tests [Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-Revised] which were used to establish diagnoses according to standard diagnostic criteria (DSM-IV), and results were compared. Results: In a cohort of 224 patients, 35% fulfilling clinical diagnostic criteria for dementia, TYM proved easy to use and acceptable to patients. Downward adjustment of the TYM test cutoff to <= 30/50, compared to <= 42/50 used in the index study, proved necessary to maximise test accuracy and specificity. Using this revised cutoff, TYM showed comparable diagnostic utility (sensitivity 0.73, specificity 0.88, positive predictive value 0.77, negative predictive value 0.86 and area under receiver operating characteristic curve 0.89) to the MMSE and the Addenbrooke's Cognitive Examination-Revised for the differentiation of cases of dementia from non-dementia. Conclusions: TYM is a useful screening test in the cognitive function clinic setting, with patients who fall below the designated cutoff requiring further investigation to ascertain a cause for their cognitive impairment. Self-administered tests such as TYM may be of particular value in situations where clinician time is limited. Copyright (C) 2010 John Wiley & Sons, Ltd.