Validation of a new cognitive screening tool, the Brain Health Test‐7, for identification of mild cognitive impairment and early dementia

Abstract Background The Brain Health Test‐7 (BHT‐7) was developed to identify patients with mild cognitive impairment (MCI) and early dementia. Here we report the validity of the BHT‐7 versus the Mini‐Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in subjects of different psychiatry or neurology clinics. Method Patients with the chief complaint of memory decline were recruited in this study from the outpatient clinic of psychiatry or neurology in 3 different kinds of hospitals between November 2017 to December 2020. All patients underwent the evaluation of the BHT‐7, MMSE, MoCA, and CDR by trained research assistants or board‐certified psychologists. The final clinical diagnosis (normal, MCI, dementia) was made by consensus meeting, taking into account all available data, including clinical history and symptoms, brain image, cognitive tests, and CDR. Demographic data (age, gender, and education level) and the scores of the MMSE, MoCA, and BHT‐7 between groups were compared. Logistic regression was adopted for analysis of optimal cutoff values, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the ROC curve. Result We enrolled a total of 1090 subjects (normal 402, MCI 317, dementia 371); of them, 705 (64.7%) were female. There was a statistically significant difference in age, years of education, and 3 cognitive test scores among the 3 groups of subjects. Compared with the MMSE and MoCA, the BHT‐7 performed slightly better in differentiating MCI and dementia. In sub‐group analysis (divided based on 6 years of education), the BHT‐7 still performed slightly better than MMSE and MoCA. The testing time for the BHT‐7 was about 5‐7 minutes, shorter than that of the MMSE and MoCA. For BHT‐7, the cutoff point was 17 between normal and MCI, and 14 between normal and dementia. These cutoff points of BHT‐7 were consistent through 3 different settings (medical center’s psychiatry and neurology clinics, and outpatient clinic of a psychiatry center). In contrast, the cutoff points were inconsistent for MMSE and MoCA in different settings. Conclusion The results support that BHT‐7 may be a useful cognitive screening tool for MCI or early dementia in various clinic settings.