The Mini-Mental State Examination (MMSE) is commonly used by clinicians to screen patients for cognitive impairment, but its sensitivity for detecting early cognitive impairment is less than ideal. To determine whether the Visual Association Test (VAT), an easy-to-administer test of associative memory, could bolster the predictive value of the MMSE, investigators in the Netherlands analyzed data from patients ages 70 to 78 years who were cognitively healthy at baseline. Of the 2,648 evaluated, 157 (5.9%) were later diagnosed with dementia (median, 6.7 years).

The risk of dementia was higher among those who had had at least a two-point drop in the MMSE score at two years (odds ratio [OR], 3.55) and among those with an imperfect VAT score at that time (OR, 3.28). But when a two-point drop in the MMSE score was combined with an imperfect VAT score, the OR rose to 9.66. Having an imperfect VAT score markedly improved the predictive value of a two- or three-point drop in the MMSE, from 10.1% to 14.4% and from 20.8% to 29.3%, respectively. Among those with a one-point drop in the MMSE (which, used alone, has uncertain significance), an imperfect VAT score was associated with a twofold greater risk of dementia, indicating that using the VAT in older adults with a minor drop in the MMSE can help identify those at increased risk for dementia, who will need further attention, the authors write.-EM

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