DOI: 10.1002/alz.072805 ISSN: 1552-5260

A new non‐verbal was developed to differentiate dementia and non‐dementia people and the study was to evaluate its validation

Guan‐Tsz Huang, Kuan‐Ying Li, Ling‐Chun Huang, Yuan‐Han Yang
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



Dementia, which presents as cognitive decline in one or more cognitive domains affecting function, is increasing globally. Early diagnosis of dementia for general population is important, which needs a screening tool capable of identifying dementia efficiently.

Most cognitive tests for screening dementia are based on verbal administration, which will be influenced by cultural background and language differences, if any.

Developing a screening tool less depended on verbal administration is crucial for these necessities.


Participants aged from 50 to 89 years old were recruited from department of Neurology, Kaohsiung Municipal Ta‐Tung Hospital, Taiwan. Dementia was diagnosed based on clinical diagnosis with referring to cognitive test performance by psychologists by 2011 National Institute on Aging and Alzheimer’s Association (NIA‐AA) criteria for all‐cause dementia .Participants were assessed with Clinical dementia rating (CDR), Cognitive Abilities Screening Instrument (CASI), derived Mini‐Mental State Examination (MMSE) and the non‐verbal cognitive test consisted of visual memory test, digital connection test, clock puzzle, shape color matching and simple card sorting test. These tests were designed to capture cognitive function including visual memory, visuospatial ability, and executive function. Statistical analysis was performed using MedCalc, version 20.14.


In total, 160 demented patients and 81 non‐demented participants were recruited. The performance of the dementia group was worse than that of the control group in all non‐verbal tests. Among these tests, visual memory had the greatest ability to examine dementia with its percentage of recalled visual memory with optimal cut‐off point 70% having a sensitivity 73.38%,specificity 85.19% and area under the curve (AUC) as 0.87. Combining visual memory test, the digital connection test‐1 and the clock puzzle‐1 to discriminate dementia, the AUC was 0.93 and was superior to the AUC of MMSE (AUC = 0.88).


Compared to traditional pencil‐paper tests, non‐verbal tests shown its potentials in screening dementia with fewer language limitation.

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