What Is the MIS (Memory Impairment Screen)?

What Is the Memory Impairment Screen?

The MIS is a brief screening tool to assess memory. It is often used as a preliminary test along with other screening tools to evaluate the cognition of someone who seems to display some possible impairment in their ability to think and recall.

Read more: 4 Types of Memory that Everyone Has

The MIS is one of three tools recommended for use in the Medicare Annual Wellness Visit by the Alzheimer's Association.

The other two are the GPCOG and the Mini-Cog.

What Components Does the MIS Contain?

If "Maude" is being given the MIS, she will be asked to perform the following tasks:

  1. Four words in large print (24 font or larger) are shown to Maude and she is asked to read each item aloud. For example, the four words may be checkers, saucer, telegram and Red Cross.
  2. Maude is then given a category and asked to identify which word fits that category. For example, the category of "games" is provided and she must be able to identify that the word "checkers" fits that category. After completing this task for all four words on the paper, the paper is removed from sight and Maude is told that she will have to remember these words in a few minutes.
  3. Next, Madue is asked to perform a task that distracts her from the four words she just learned, such as counting to 20 forwards and backwards or counting backwards by sevens starting at 100.
  1. After completing this distracting task, Maude is asked to recall the four words. She is given at least 5 seconds to remember each of the words. This is called the free recall section of the test because she is being asked to remember the words but not given any clues to do so.
  2. If more than 10 seconds have passed with no words recalled,  Maude is then given the categorical clue for each word and asked to recall the word. For example, the test administrator will say that one of the items was a game and this might prompt Maude to remember the word "checkers." This is the cued recall section of the test.

    How Is the MIS Scored?

    For each word recalled without any clues (free recall), Maude will receive two points. For each word recalled with the categorical clue, Maude will receive one point.

    A score of 5-8 indicates no cognitive impairment, while a score of 4 or below points to possible cognitive impairment.

    How Well Does the MIS Work to Identify Dementia?

    The MIS has been shown to be more effective in identifying cognitive impairment and less costly than the standard Mini Mental State Exam. (The MIS is copyrighted by the Albert Einstein College of Medicine but clinical use is free.)

    What Are the Pros and Cons of the MIS?

    Pros

    • The MIS does not require the ability to write, so it's a good choice if motor function is impaired.
    • It's brief, requiring about four minutes to administer.
    • Performance on the MIS shows little effect of education level. (Someone who has gone to school through 6th grade should be able to perform just as well as someone with a college education.)
    • The MIS remains accurate when used in multiple cultural settings and in different languages.
    • It does not require extensive training to administer.
    • There is also a MIS-T screening which is a version of the MIS that can be administered over the telephone. Research has shown that the MIS-T is effective in detecting cognitive impairment.

    Cons

    • One caution with the MIS is that it can't be used with persons who are unable to read, whether due to a visual impairment or due to illiteracy.
    • It does not evaluate executive functioning, which can be an early symptom in some types of dementia including vascular dementia and frontotemporal dementia.
    • It does not evaluate visuospatial ability, which also can be affected by dementia.

    Diagnosing Dementia

    Remember that the MIS is a screening tool, not a definitive diagnostic tool. Poor performance on the MIS indicates that there may be a reason to be concerned, but a full physician assessment is necessary to evaluate cognition and eventually diagnose dementia. Keep in mind that there are some causes of memory impairment that can be at least partially reversible with appropriate treatment, such as vitamin B12 deficiency, medication interactions, delirium and normal pressure hydrocephalus.

    Sources:

    Alzheimer's Association. Albert Einstein College of Medicine. Accessed September 25, 2014. Memory Impairment Screen. http://www.alz.org/documents_custom/mis.pdf

    Alzheimer's Association. The Cognitive Assessment Toolkit.

    Alzheimer’s & Dementia 9 (2013) 141–150. Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. http://www.alzheimersanddementia.com/article/S1552-5260%2812%2902501-0/abstract

    BMC Neurology. 2011, 11:92. Effectiveness and costs of phototest in dementia and cognitive impairment screening. http://www.biomedcentral.com/1471-2377/11/92

    Journal of the American Geriatric Society. 2003 Oct;51(10):1382-90. Screening for dementia by telephone using the memory impairment screen. http://www.ncbi.nlm.nih.gov/pubmed/14511157

    Neurology. 1999 Jan 15;52(2):231-8. Screening for dementia with the memory impairment screen. http://www.neurology.org/content/52/2/231.short

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