![]() ![]() We performed a comprehensive validation of the previously developed BMET, evaluating it in 19 stroke centres throughout England, with administration of the BMET by doctors and research nurses rather than neuropsychologists. In a preliminary study, the BMET accurately differentiated VCI due to SVD from CI due to Alzheimer’s disease, with a sensitivity of 91% and specificity of 85%. It is primarily for screening VCI in patients with SVD, helping differentiate such deficits from those found in patients with cortical dementias it incorporates specifically adapted measures of executive functioning and processing speed, designed to be brief but sensitive, combined with measures of memory functioning. ![]() The Brief Memory and Executive Test (BMET) was designed to provide a cognitive screen taking approximately 10 minutes, which would be suitable for use by health professionals in in- and out-patient settings. The lack of a widely available validated screening tests for this group has been recognised in the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards, which proposed specific cognitive protocols, but these take a minimum of 20 to 60 minutes to complete. However, despite this, VCI associated with SVD is often missed in a clinical setting.Ī key contributing factor to under diagnosis is the current use of cognitive screening measures, such as the Mini Mental State Examination (MMSE), that have been developed primarily for the assessment of cortical dementias such as Alzheimer’s Disease and have been shown to be insensitive to the cognitive deficits found in patients with VCI due to SVD. Cognitive impairment (CI) in patients presenting with lacunar stroke or other manifestations of SVD is common, with up to 50% of patients with lacunar stroke having some degree of cognitive impairment, which predicts subsequent progression to vascular dementia, and has been shown to have a major impact on quality of life. VCI due to SVD is associated with a characteristic profile of impairment in cognitive flexibility, attention, and processing speed with a relatively spared performance on memory tasks. The BMET is a brief and sensitive tool for the detection of cognitive impairment in patients with SVD.Ĭerebral small vessel disease (SVD), which causes lacunar stroke accounting for 10 to 30% of all ischemic strokes, is the major cause of vascular cognitive impairment (VCI) and vascular dementia. Using a cut-off score of 13, the BMET had a sensitivity of 93% and specificity of 76% for detecting cognitive impairment in SVD. Receiver Operator Curve analysis showed the BMET was a good predictor of cognitive impairment in SVD (AUC = 0.94) and performed significantly better than both the MoCA (AUC = 0.77) and the MMSE (AUC = 0.70). ResultsĪdministering the BMET took a mean (SD) of 12.9 (4.7) in cases and 9.5 (2.6) minutes in controls. Overall, 55 SVD participants underwent repeat testing at 3 months to assess the BMET test-retest reliability. The BMET, as well as the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE), were performed. Two-hundred participants with SVD, defined as a clinical lacunar stroke and a corresponding lacunar infarct on MRI, and 303 healthy controls aged between 40–90 years old were recruited. To assess the BMET’s validity for general use, we evaluated it when administered by non-psychologists in a multicentre study and collected control data to derive normative scores. We developed the Brief Memory and Executive Test (BMET) a rapid screening measure sensitive to the impaired executive function and processing speed characteristic of small vessel disease (SVD). Cognitive impairment is common in patients with cerebral small vessel disease, but is not well detected using common cognitive screening tests which have been primarily devised for cortical dementias. ![]()
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