title: Development of a novel computerised version of the Month Backwards Test: A comparison of performance in hospitalised elderly patients and final year medical students.
abstract: OBJECTIVE
  The Months Backwards Test (MBT) is a commonly used bedside test of cognitive function, but there is uncertainty as to optimal testing procedures. We examined performance among hospitalised elderly patients and cognitively intact young persons with verbal and computerised versions of the test.
  
  
  METHODS
  Fifty acute elderly medical inpatients and fifty final year medical students completed verbal (MBTv) and computerised (MBTc) versions of the MBT and the Montreal Cognitive Assessment (MoCA). Completion time and errors were compared.
  
  
  RESULTS
  Thirty four participants scored <26 on the MoCA indicating significant cognitive impairment. The mean MoCA scores in the elderly medical group (23.6±3.4; range 13-28) were significantly lower than for the medical students (29.2±0.6; range 28-30: p<0.01). For the verbal months backwards test (MBTv), there were significantly more errors and longer completion times in the elderly medical patients (25.1±20.9 vs. 10.5±4.5; p<0.05). Completion times were 2-3 times longer for the MBTc compared to the MBTv (patients: 63.5±43.9 vs. students 20.3±4.4; p<0.05). There was high correlation between the two versions of the MBT (r=0.84) and also between the MBTc and the MoCA (r=0.85). The MBTc had higher correlation with visuospatial function (MBTc r=0.70, MBTv r=0.57). An MBTc cut-off time of 30s for distinguishing performance (pass/fail) had excellent sensitivity (100%) with modest specificity (44%) for cognitive impairment in elderly medical patients.
  
  
  CONCLUSIONS
  The computerised MBT allows accurate and efficient testing of attention and general cognition in clinical populations.
authors.affiliation: University of Limerick Graduate Entry Medical School, Limerick, Ireland.
authors.forename: Laura
authors.initials: L
authors.lastname: Donoghue
authors.affiliation: Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Ireland.
authors.forename: Tiago
authors.initials: T
authors.lastname: Elias
authors.affiliation: University of Limerick Graduate Entry Medical School, Limerick, Ireland; Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Ireland.
authors.forename: Maeve
authors.initials: M
authors.lastname: Leonard
authors.affiliation: University of Limerick Graduate Entry Medical School, Limerick, Ireland; Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Ireland.
authors.forename: Chris
authors.initials: C
authors.lastname: Exton
authors.affiliation: University of Limerick Graduate Entry Medical School, Limerick, Ireland; Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Ireland.
authors.forename: Colum
authors.initials: C
authors.lastname: Dunne
authors.affiliation: Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Ireland.
authors.forename: James
authors.initials: J
authors.lastname: Meagher
authors.affiliation: University of Limerick Graduate Entry Medical School, Limerick, Ireland; Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Ireland; Sligo-Leitrim Mental Health Services, Sligo Regional Hospital, Ireland.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Adamis
authors.affiliation: University of Limerick Graduate Entry Medical School, Limerick, Ireland; Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Ireland; Department of Psychiatry, University Hospital Limerick, Ireland. Electronic address: david.meagher@ul.ie.
authors.forename: David
authors.initials: D
authors.lastname: Meagher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012984:Software
keywords: Assessment; Cognition; MoCA; Months Backwards Test