An Exploration Of Memtrax Memory Cognition Test For The Evaluation Of Mild Cognitive Impairment And Dementia

Objective(s):Memtrax is an emerging online cognitive assessment test,this study aims to assess it’s utility in mild cognitive impairment and dementia for assessing cognitive function in the context of clinical setting,and finding optimized cutoffs for the differentiation of MCI from normal control(NC),and differentiation of dementia from MCI.To compare the correlations between Memtrax test scores and the MoCA domains to determine the association of each domain with the Memtrax metrics.To explore whether the risk factors that affect the cognition of dementia would affect the diagnostic efficiency of Memtrax in dementia or mild cognitive impairment.Methods:During the time from February 2019 to February 2020,patients were recruited from the outpatient and inpatient geriatrics departments in the Affiliated Mental Health Center of Kunming Medical University,they were diagnosed using the diagnostic criteria DSM-5 as standard,with the estimation results of MoCA,CDR,ADL,GDS,finally enrolled 37 dementia patients,47 MCI patients,at the same time,we enrolled 31 family members of the patients or retired staffs as normal control(NC)using the same diagnostic criteria.After the neurological examinations above were finished,Memtrax was administered on the subjects,four Memtrax metrics was recorded,they included MTX-%C,which means the percentage of correct responses to all of the presented pictures,MTX-RT,which means the average reaction time in seconds for repeated images,MTX-speed,which was acquired by dividing 1 by the MTX-RT.MTX-CP,which was derived by multiplying the MTX-%C and the reciprocal of MTX-RT.We also recorded the total score of MoCA,the scores of every individual MoCA domains,the record of every participants’ demographic information,and the risk factors of cognitive decline in dementia,(including the age,sex,education,psychiatric medication history,family history of dementia,diabetes,hypertension,hyperlipidemia,depression,history of smoking,drinking,brain trauma history,history of hypothyroidism,work type,living alone or not,cerebrovascular disease,recent history of insomnia),after the completion of the various parameters above,we evaluated diagnostic value of Memtrax for in different degree of cognition decline using the Memtrax AUC of each Memtrax metrics,and got optimized cutoffs of the Memtrax metrics.And we compared the correlation between each Memtrax metrics with the MoCA domains,to further explore the relationship between Memtrax and dementia cognitive function,at the same time,we compared the the differences of the risk factors in the three group,risk factors those significantly different among the three groups(P<0.01)and Memtrax metrics were taken as independent variables,and the total score of MoCA was taken as dependent variable.multiple linear regression analysis was used to explore the influence of risk factors of cognitive dysfunction in different degree of cognitive decline on the performance of Memtrax cognitive function assessment,the analyses above were achieved using SPSS23,graphpad prism7 and MedCalc.Results:1.MTX-%C,MTX-CP were significantly lower in the MCI group as compared to the NC group(P<0.01)and in the dementia group as compared to the MCI group(P<0.01),the MTX-RT were significantly longer in the MCI group as compared to the NC group(P<0.01)and in the dementia group as compared to the MCI group(P<0.01).According to the present research,the AUC of the Memtrax metrics in differentiating from the NC group to MCI group were:0.78,0.84,0.75,regard to the ROC curve analysis of MTX-%C,the corresponding cutoff was 0.54 when there get the biggest youden index,and the sensitivity was 87.1%,specificity was 74.5%.When it comes to differentiation from the dementia group to MCI group,the AUC of the Memtrax metrics were:0.93,0.93,0.72,regard to the MTX-%C,the corresponding cutoff was 61%when there get the biggest youden index,and the sensitivity was 91.5%,specificity was 89.2%,and regard to the ROC analysis test of MTX-CP,the corresponding cutoff was 0.41 when there get the biggest youden index,and the sensitivity was 83%,specificity was 91.9%.2.All of the Memtrax metrics were significantly associated with the total score and every MoCA domains scores(P<0.01),the mean correlation between MTX-%C,MTX-speed,MTX-CP and these cognitive domains were 0.59、0.42、0.58.The mean correlation between each cognitive domains and Memtrax metrics was ranked as follows:MoCA total score(r=0.7158),visuospatial executive function(r=0.6208),orientation(r=0.5873),delayed recall(r=0.5640),language(r=0.4892),attention(r=0.4823),animal naming(r=0.4034),abstraction(r=0.3808).The correlations between MTX-%C and MoCA total score,visuospatial executive function,orienting,delayed recall,language,and attention were 0.78,0.71,0.62,0.60,0.52,0.60,the correlations between MTX-CP and MoCA total score,visuospatial executive function,orientation,delayed recall,language,and attention were 0.80,0.68,0.66,0.62,0.54,and 0.43,the correlations between MTX-speed and MoCA total score,visuospatial executive function,orienting,delayed recall,language,and attention were 0.56,0.46,0.48,0.46,0.40,0.42.3.There were significant differences between the three groups in age and the history of psychiatric drugs intake(P<0.01),we conducted a multiple linear regression analysis using all of the Memtrax metrics,the use of psychiatric drug,age as independent variables,and the total score of MoCA as dependent variable,the result suggested that only psychiatric drug use,MTX-%C,MTX-RT was included in the model,and the standardized coefficients of MTX-%C,MTX-RT and the use of psychiatric drug were 0.65,-0.22,-0.17.The R2 of the model is 0.68,which means all of the independent variables could explain 68%variation in total scores of MoCA.Conclusion(s):1.Memtrax,as a cognitive assessment tool,can well distinguish normal population,MCI and dementias.For the differentiation of MCI from NC,the result of present study suggests that we can use a cutoff of 0.54 in MTX-CP as a reference,and for the differentiation of dementias from MCI,the result of our study suggests to use a cutoff of MTX-%C 61%or a MTX-CP cutoff of 0.41as reference.2.All of the Memtrax metrics significantly associate with overall cognitive function and the cognitive dimensions(P<0.01),and there are relatively robust correlations between MTX-%C,MTX-CP and overall cognitive function as well as each cognitive dimension such as visuospatial executive function,delayed recall.3.It is possibly that the influence of age and the psychotropic drugs use in Memtrax cognitive evaluation on mild cognitive impairment and dementia are weak.