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Testing to Screen for Mild Cognitive Impairment (MCI)* and Alzheimer's Disease Risk

The tests that comprise the CANS-MCI are automated tasks which test ability on multiple cognitive dimensions, not just memory. All dimensions tested have been found in multiple independent studies to be those cognitive dimensions most predictive of Alzheimer's Disease (AD). Impairment on these dimensions can be caused by factors other than impending Alzheimer's, so the tests are best used longitudinally in primary care offices before referral for full neuropsychological evaluation.
Only a combination of tests, including memory tests, can adequately detect the important changes because the first changes indicating AD are not the same in all people. Single dimension tests, particularly those administered over the web, focus entirely upon only one of the dimensions that need to be measured in primary care offices.

The Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI):
The CANS-MCI is the only comprehensive test battery that is fully self-administered in primary care offices without needing staff training or administration time, yet it is a reliable, valid predictor of the need to refer people for full neuropsychological and imaging evaluations.
Some other test batteries claim to be self-administered, but all tests that involve use of the computer keyboard or mouse require monitoring by a staff member. Tests administered over the web, unless performed in a controlled office setting with a trained staff member present, often have major reliability problems, caused by factors such as distractions or family coaching. The CANS-MCI is administered in the controlled settings of medical facilities, usually in neurology, geriatric psychiatry or primary care offices, where distractions and coaching by family can be eliminated, but no staff time or training is necessary. The test reports are returned, within the hour after testing, to medical personnel for review with the patient. Reports are not returned directly to patients or the public.

The CANS-MCI was developed over a seven-year period and subjected to rigorous usability, reliability, and validity research study, supported by grants from the Veterans Administration and the National Institute on Aging. The tests have already met high standards in both usability, sensitivity, specificity, and concomitant validity. They have been recognized by clinicians and, even by our competitors**, for their unique contribution to early screening. We continue to refine the longitudinal comparison scoring of the tests, so that we may better detect the earliest signs of Mild Cognitive Impairment. Refinements to scoring can be applied to all previous testing via our encoded central database operation. You may download a Demo test installer (not qualified for Windows7) with a set of the tests in a form that does not take over the whole screen, does not collect data, and can be taken with a mouse in English or Spanish.*** If you wish to see a multimedia presentation about the test development and validation research, you may download an installer for the multimedia presentation.***

The CANS-MCI tests are designed to signal the need for a full neuropsychological or imaging evaluation when signs of Mild Cognitive Impairment (the highest risk factor for impending Alzheimer's Disease) are detected. Full evaluations would then be done in person by specialists, usually by neurology or neuropsychology specialists. Those lengthy evaluations are expensive and often stressful. Due to the expense of screening in primary care offices, the full evaluations are too often delayed until symptoms are relatively advanced. Screening is necessary because mild cognitive impairments cause life-threatening medication and driving errors, and so that family decisions about symptom-delaying medications, care plans, and finances can be made. Failure to screen in primary care (if only to establish a baseline for comparisons) will also be tragic because experimental medications now being tested for Alzheimer's are designed to slow the progress of the disease, not reverse it. The earliest detection will mean the maintenance of the highest levels of cognitive ability.

Only with the CANS-MCI can doctors screen without using staff time, training staff members, or risking unreliable test administration or scoring. The screening clarifies the need to refer for more expensive expert evaluations, even for highly educated patients who still score above average despite significant deterioration. With the CANS-MCI, doctors have baseline scalable measurements against which changes over time and the effects of medication trials may be measured.

We offer a package of free test software that may be used on a touch screen computer monitor by patients with no previous computer experience at a medical facility or approved retirement facility. Charges are made for scoring and interpretation at our offices. We are always creating more precise scoring formulas for prediction (higher levels of sensitivity and specificity), as the longitudinal, imaging, and autopsy data expand. The central database model allows us to apply more predictive scoring to all existing test data so that older scoring methods for the tests are never outdated in longitudinal comparisons.

Test interpretations are given with graphical score displays only to the professional clinician who, in turn, reviews them with their patients. Test results are not given directly to patients. since awareness of results, even for screening, can have adverse psychological effects and should be conveyed and/or acted upon only by qualified health professionals.

If you wish to see a multimedia presentation about our test development efforts and research, you may download an installer here.***

* Mild Cognitive Impairment (MCI) refers to the set of cognitive impairments that are most predictive of Alzheimer's disease. It is beginning to also refer to the subset of brain features that are characteristic of Alzheimer's but are also in between normal brains and those of Alzheimer's patients. MCI is sometimes referred to as an early stage of Alzheimer's, sometimes as a precursor. People with MCI are most often, although not necessarily, in a transitional phase between normal brain functioning and Alzheimer's.

** "Congratulations on creating the most beautiful and intuitive user interface for cognitive testing that I have yet seen. Your use of multi-media developers for the CANS-MCI human-computer interface really paid off. The CANS-MCI is certainly the best self-test on the market."
William R. Shankle
Chief Medical Officer
Medical Care Corporation
Co-presenter at the Early Diagnosis and Intervention Symposium, Alzheimer's Association's International Conference on Prevention of Dementia: July 20, 2005, Washington, DC.

*** Note: Do not operate other web-related programs during these downloads. Expect the download to take a few minutes on a DSL broadband connection, since it includes sound and hearing-impaired versions for both English and Spanish. Save the installer files to your Desktop. The Multimedia Presentation installer is a .zip archive. After it has been saved to the Desktop, it must be extracted to a new folder (right click and "Extract Here") and then you can start the setup process. The CANS-MCI Demonstration installer is self-extracting application. Just double-click it and follow instructions within the installer window.

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