J Neurol. 2014 Feb;261(2):422-31. doi: 10.1007/s00415-013-7219-1.

The 5 Objects Test: a novel, minimal-language, memory screening test.

Papageorgiou SG, Economou A, Routsis C.

Cognitive Neurology-Extrapyramidal Disorders Unit, 1st University Department of Neurology, Eginition Hospital, Medical School, University of Athens, Athens, Greece.

 

Abstract

Very brief screening tests are useful in primary care, but may show reduced sensitivity in detecting Alzheimer’s disease or other dementias in the early stages and may show an education or age bias. We examined the reliability, validity, sensitivity, specificity and relationship with demographic variables of a novel, very brief memory screening test that makes limited language demands. Participants were 452 neurological patients with different diagnoses and a community-dwelling sample of 119 middle-aged and older controls. The 5 Objects Test requires the recall of the locations of five everyday objects, immediately after placement and after a brief period of time. The test was unaffected by age and education and showed good reliability and discriminant validity. In receiver operating characteristic (ROC) analyses, specificity was high across a range of sensitivities in all four main comparisons (AD cases versus controls; all dementia cases versus controls; memory-impaired versus non memory-impaired patients; MCI cases versus controls), and sensitivity was lowest in differentiating MCI cases from controls. The test showed similar areas under the ROC curve to the much longer modified Mini Mental State Examination. The 5 Objects Test is a reliable and valid very brief screening test that is suitable for primary care. Because of its limited linguistic demands, the test is appropriate for persons with limited language use or from different linguistic backgrounds.

PMID: 24371005

 

Supplement:

Out of sight, out of mind: the role of the hidden object in a novel, minimal-language, memory screening test

Alexandra Economou, Ph.D.1;Sokratis G. Papageorgiou, M.D., Ph.D.2

1Department of Psychology, School of Philosophy, University of Athens, Athens, Greece.

2 Cognitive Disorders – Dementia Unit, 2nd University Department of Neurology, ATTIKON University General Hospital at Haidari, University of Athens, Athens, Greece.

Correspondence: Alexandra Economou, Ph.D. Department of Psychology, School of Philosophy, The University of Athens, Panepistimiopolis, Ilissia 157 84, Athens, Greece. Tel.: +3210-727 7589; e-mail : aoikono@psych.uoa.gr

 

Abstract

The 5 Objects test is sensitive to dementia but may be differentially sensitive to different patient groups. Moreover, because one of the five objects is hidden from view, the objects may not be recalled with the same frequency by different patient groups. Comparisons of recall performance in Alzheimer’s disease (AD) patients (n=106), frontotemporal dementia (FTD) patients (n=49), and Parkinson’s Disease Dementia/Dementia with Lewy Bodies (PDD/DLB) patients (n=26) in Trials 1, 2, and delayed recall showed that the AD patients recalled fewer objects than the other two groups. Chi-square test of independence showed a significant difference in the frequencies of the three patient group distributions by test object. Across all trials, the lowest performance was observed in the AD group in recall of the position of the watch, the object that the examiner visibly hid in his/her pocket during the placement of the objects. The analyses by test object show, that in addition to greater deficits in learning and rapid forgetting, AD patients have particular difficulty retaining information that is out of their field of view.

 

Supplement

The 5 Objects Test shows sensitivity to different types of dementia but it is unclear which component of the test creates the most difficulty and for which patient group. During placement of the objects, one of the objects is placed in the pocket of the examiner, in full view of the examinee, while the examiner verbally describes the action, rather than on the two adjacent sheets of A4 paper. During the testing portion, each object is removed after its placement on the two sheets of paper in front of the examinee, irrespective of its correctness, which challenges the memory of the examinee. It is hypothesized that the hidden object poses the greatest difficulty for patients with Alzheimer’s disease (AD), who may try to place all five objects on the two sheets of paper. We sought to compare the recall performance of three patient groups and to examine which of the test objects present the greatest difficulty for the patients.

Comparisons were performed on the 106 AD patients, the 49 frontotemporal dementia (FTD) patients, and the 26 Parkinson’s Disease Dementia/Dementia with Lewy Bodies (PDD/DLB) patients in terms of overall performance and performance on the individual test items. Figures 1, 2, and 3, show the performance of the 119 control participants and the three patient groups on Trials 1, 2, and delayed recall, respectively.

AE Figure1

Figure 1. Proportion correct per test object in Trial 1

AE Figure2

Figure 2. Proportion correct per test object in Trial 2

 

 

AE Figure3

Figure 3. Proportion correct per test object in delayed recall

The Figures show differences in overall performance, as expected, with the AD patients scoring lower than the other two patient groups, consistent with their pathology, and the control group showing near ceiling performance on all trials. In Trial 1 there was an overall difference among the three patient groups [F(2, 178) =12.86, p<.0001]. Post-hoc comparisons (Bonferroni correction) showed that the AD patients scored lower than the FTD patients (p<.0001) and the PDD/DLB patients (p<.01). In Trial 2 there was an overall difference among the three patient groups [F(2, 178) =15.99, p<.0001]. Post-hoc comparisons (Bonferroni correction) showed that the AD patients scored lower than the FTD patients (p<.0001) and the PDD/DLB patients (p=.001). In delayed recall there was an overall difference among the three patient groups [F(2, 178) =16.39, p<.0001]. Post-hoc comparisons (Bonferroni correction) showed that the AD patients scored lower than the FTD patients (p<.0001) and the PDD/DLB patients (p<.01). No differences were found between the FTD and PDD/DLB patient groups in any comparisons.

More interesting for the purposes of our study was the differential performance by test object. As can be seen in the Figures, the lowest performance was observed in the AD group in recall of the position of the watch, the object that the examiner visibly hid in his/her pocket during the placement of the objects. This deficient performance relative to the performance of the other objects was maintained in Trial 2 and in delayed recall.

The above observations were corroborated by chi-square test of independence, which showed a significant difference in the frequencies of the three patient group distributions. The distribution differences by test object for each trial (Trial 1, Trial 2, delayed recall) are shown in Table 1.

 

Table 1. Distribution of test object by Trial

AE TAB1

 

In Trial 1 the watch is placed correctly less frequently by the AD patients relative to the other two patient groups, as is the pen to a lesser extent. In Trial 2 all objects with the exception of the phone are placed correctly less frequently by the AD patients relative to the other patient groups, the difference being more salient in the watch. This shows that the AD patients have greater difficulty learning the information when the trial is repeated, consistent with their pathology. In delayed recall all objects are placed correctly less frequently by the AD patients, reflecting greater forgetting. Again, the difference is more salient in the recall of the position of the watch. The results show that the hidden object, the watch, creates the greatest difficulty for the AD group across the trials. The differences are most salient in Trial 1 (Figure 1) but remain evident in delayed recall (Figure 3), where the other two patient groups do not show notable differences in the distribution of recall performance by object.

It may be argued that the placement of each object is not truly independent, despite the removal of each object after placement. Both the initial order of presentation of the objects and the recall of where the previous object was placed during testing may facilitate object placement. Note, however, that the watch is presented last during object placement and third during testing, so if anything, it should be facilitated by recency effects. The analyses by test object show, that in addition to deficient learning and rapid forgetting, AD patients have particular difficulty retaining information that is out of their field of view.

 

 

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