Psychometric Evaluation of the Persian Version of Illustrated Memory Impairment Screen (PIMIS) Test in Elderly Patients with Alzheimer’s Disease in Iran

Abstract

Background: The memory impairment screen (MIS) test is a brief, four-item, delay-free, and cued-recall test of memory impairment. It is highly correlated with Alzheimer’s pathology and can be easily used by trained non-specialists. However, the application of this test might be restricted due to minimum literacy levels requirement. The picture based MIS (PMIS) is a modified version that can be used by even illiterate or low-education people. The pictures can be adapted based on cultural differences. Objectives: The aim of this study was to provide and validate the Persian version of illustrated memory impairment screen (PIMIS) test in elderly patients with Alzheimer’s disease in Iran. Methods: This validation was a cross-sectional study on people 60 years of age and older with different levels of education (illiterate to > 13 years of education). The participants consisted of subjects with normal cognition, subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and different types of Dementia. Cognitive impairment was diagnosed by a neurologist with expertise in dementia (gold standard). The validity was assessed by comparing MISIP with the gold standard. Area under ROC curve, optimal cut-point, sensitivity, specificity, and Cronbach’s alpha were estimated. Results: Data were collected from 119 participants, 38 of which were diagnosed with Dementia, 17 with MCI, 21 with SCI and also 43 had normal cognition. The PIMIS score was significantly lower in patients diagnosed with dementia compared to the other groups (7.1 versus 4.3 for PIMIS score with a P value of less than 0.001). The PIMIS had a sensitivity of 60% and specificity of 91% for detecting dementia at a cut-point of five. Level of education had no significant effect on the test. Conclusions: IMIS is a simple reliable screening test in elderly population with variable literacy rates.