Psychiatry and the Potential of Digital Tools（Series ＃5）
The Second Part: Brief Cognitive Function Assessment Scale in Middle Age and Beyond “The MCI Screen (Atama no Kenko Check)”
Medical communication, Disease management and Patient monitoring, Japan, Digital Therapeutics (DTx), Patient data, Telemedicine, Clinical Doctor, Examination and Diagnosis
Details of the Test Method and Examples of Use in Clinical Research and Municipalities
In the previous article, we provided an overview of “The MCI Screen (‘Atama no Kenko Check’ in Japanese)” as a tool for evaluating cognitive function from the early stages of the disease. In this article, we will introduce the specifics of the system and examples of its use in clinical research, and so on.
The “The MCI Screen” evaluates cognitive function in three main processes1). The first is an immediate replay of ten words to evaluate working memory in the prefrontal cortex area. The second is an animal test (choose the animal you think is most different from the three animals) to evaluate decision-making ability. And the third is a delayed replay of the first ten words to assess short-term memory in the hippocampal area. This 10-word recall is derived from a memory evaluation task of the ADAS-Cog*1, which is believed to be able to evaluate the state of cognitive functions using its unique statistical analysis technology quantitatively and accurately. Each time, a different set of words is used to eliminate learning effects during repeated testing. Furthermore, the analysis considers not only the number of words recalled but also recall pattern variability and serial position effects, which are biases in how words are recalled. The results are automatically weighted by gender, age, and years of study experience, and are presented as a unique index called the MPI（Memory Performance Index） score (0-100). It enabled easy-to-understand observation of changes in cognitive function over time in subjects recommended for prevention in the normal to MCI range, which has been challenging to assess function in the past.
Naturally, validity assessments have also been conducted. Surprisingly, studies that have compared its assessment results with those of our clinically used Mini-Mental State Examination (MMSE) *2, Cerebral Blood Flow SPECT*3, and Quantitative Analysis of Head MRI (VSRAD: Voxel-based Specific Regional analysis system for Alzheimer's Disease) *4 have confirmed its assessment capability with high sensitivity and specificity2). It is noteworthy that such a high level of results can be obtained by non-medical personnel in only ten minutes. It is also helpful as the first screening tool when considering the promotion of work style reform and optimization of test operation efficiency by medical personnel while ensuring medical care quality. In addition, since the test covers people without dementia and measures the “healthiness of the brain,” which triggers preventive activities without confirming the dementia or non-dementia, the test taker feels little resistance to the test. As we realize clinically, conducting a cognitive function test on a person suspected of having dementia can be offensive to the dignity of the person being tested, and in some cases where people have refused to take the test. The test can be conducted with a high degree of accuracy, is an indicator based on the recommendation of preventive activities and is less likely to cause resistance in the examinee. This fact is an essential characteristic of a screening tool.
Taking advantage of these features, the “The MCI Screen” has been applied in various situations. For example, I mentioned the Integrated Registry Of Orange Plan (IROOP) in the previous article. The IROOP is a registry of healthy individuals that also conducts cognitive function tests for dementia prevention under the New Orange Plan (Comprehensive Strategy for the Promotion of Dementia Measures) which was jointly formulated by the relevant ministries and agencies in 2015³⁾. This study was conducted jointly by the National Center of Neurology and Psychiatry (NCNP) *5 and the National Center for Geriatric Gerontology (NCGG) *6 as part of the Dementia Research and Development Project of the Japan Agency for Medical Research and Development (AMED) *7, and accumulated data for five years. Currently, the data is being integrated into the successor project, J-TRC*8.
The target population is healthy persons aged 40 and over. In addition to questionnaires on their general condition and lifestyle, they will undergo the “The MCI Screen” twice a year. Since the tests are expected to be repeated, there must be no learning effect, as mentioned above. In the final report submitted in 2019, a multiple regression analysis with the MPI score as the dependent variable and each questionnaire item as the independent variable showed that “depressed mood” and “low motivation” are linked to cognitive function decline. It also showed that good sleep contributes to maintaining cognitive function 4) 5).
There is also a growing movement to utilize this technology in various municipalities.
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