Automated Self-Administered Scale (AMES)

Abstract

The Automated Self-Administered Scale (AMES), developed by Huang et al. (2023), represents an innovative, technology-driven solution for the rapid screening of early Cognitive Impairment within primary care and community-based environments. Designed for administration on Android tablets, the AMES efficiently assesses key cognitive domains, including memory, language, and Executive Function.

A central feature of the AMES is its sophisticated approach to memory assessment, which integrates memory binding models with the theoretical framework of Parallel Distributed Processing (PDP). This integration utilizes semantic hints and paired stimuli to encourage deep semantic encoding, thereby optimizing learning and retrieval efficiency. The application of PDP specifically aids in differentiating between recognition processes—namely, familiarity versus recollection—which is crucial for identifying incipient memory dysfunction. The scale is highly accessible, relying on simplified clicking or tabbing interactions and providing all instructions via slow-paced, built-in audio to accommodate users with low vision. The entire assessment is remarkably efficient, requiring only about 10 minutes to complete. Validation studies reported comprehensive results regarding the scale’s reliability, validity, sensitivity, and specificity across diverse patient groups, including those with Mild Cognitive Impairment.

Keywords

Guided Learning, Go No Go, Number Tabbing, Delayed Recall, Cognitive Screening Tool, Cognitive Decline, Mild Cognitive Impairment, Memory, Language, Executive Function, Parallel Distributed Processing.

Authors

Huang, Lin, Mei, Zihan, Ye, Jianfeng, Guo, Qihao

Purpose

The fundamental purpose of the AMES is to function as a highly effective and streamlined instrument for screening early cognitive impairment. Its design prioritizes deployment in community-based settings, allowing for efficient, large-scale identification of individuals who may be experiencing early stages of cognitive decline.

Construct

The AMES is designed to measure three core cognitive domains often affected early in neurological decline: Memory, Language Processing Ability, and Executive Function. The memory component is particularly nuanced, focusing on the mechanisms of memory binding and the distinction between familiarity and recollection during retrieval, offering a detailed view of episodic memory integrity.

The scale employs four distinct subtests—Guided Learning, Go no Go, Number Tabbing, and Delayed Recall—to capture these constructs. For instance, the Go no Go task typically assesses inhibitory control, a key aspect of Executive Function, while the Guided Learning and Delayed Recall subtests target different phases of memory encoding and retrieval, optimized using Parallel Distributed Processing (PDP) methods.

Validity

Convergent Validity

The AMES demonstrated significant positive correlations (Convergent Validity) with several well-established cognitive screening tools. Notable correlations were observed with the Mini-Mental State Examination (MMSE) (Spearman correlation coefficient [r] = 0.436, p < .001) and the Montreal Cognitive Assessment Basic (MoCA-B) (r = 0.551, p < .001). Positive correlations were also found with specific cognitive measures such as delayed free recall (r = 0.542), memory recognition (r = 0.492), animal verbal fluency (r = 0.306), and language (r = 0.300). Conversely, negative correlations were reported with attention (r = −0.360) and Executive Function (r = −0.484).

Test Sensitivity and Specificity

The AMES exhibited strong capabilities in discriminating between patient groups and normal controls. When distinguishing patients with Mild Cognitive Impairment (MCI) from Normal Controls (NC), the scale achieved an Area Under the Curve (AUC) of 0.88, along with a sensitivity of 86% and a specificity of 80%. Furthermore, for distinguishing individuals with Objectively-Defined Subtle Cognitive Decline (obj-SCD) from NC, the AMES yielded an AUC of 0.78, with a sensitivity of 89% and a specificity of 63%.

Reliability

The reliability of the AMES was assessed using measures of Internal Consistency, calculated via Cronbach’s alpha. The results indicated relatively low internal consistency values for certain subdomains, suggesting potential item heterogeneity within those specific cognitive constructs.

Reported Cronbach’s alpha values for specific domains were: 0.17 for language processing ability (items 1 and 2); 0.38 for immediate memory (items 3 and 4); and 0.52 for Executive Function (items 5 through 8). These findings suggest that while the overall instrument is effective as a screening tool, refinement may be beneficial to improve the internal consistency of the individual subscales.

Factor Analysis

Data regarding the Factor Analysis or underlying factor structure of the Automated Self-Administered Scale (AMES) were not available in the primary source documentation.

Instrument

Test Type: Original Instrument Type: Inventory/Questionnaire

Format: The AMES is a digital scale administered exclusively on Android tablets. The user interface is designed for simplicity, primarily requiring clicking or tabbing for interaction. All test instructions are delivered via slow-paced, built-in audio to maximize accessibility, minimizing reliance on visual text. Scoring utilizes item scores and coefficients, where the sum of item scores for a pair corresponds to the maximum attempts allowed.

Language Available: No data is Available

Population Group: Human; Male; Female

Age Group: Adulthood (18 years & older); Middle Age (40-64 years)

Population Details: The study validation sample was recruited in China. The respondents included individuals diagnosed with Normal Controls (NC), Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI), and Objectively-Defined Subtle Cognitive Decline (obj-SCD).

Test Methodology: The scale was validated using comprehensive psychometric methods, including the assessment of Test Reliability (Internal Consistency), Test Validity (Convergent Validity), and clinical utility measures such as Test Sensitivity and Test Specificity.

Keywords

Cognitive Decline, Memory, Language, Executive Function, Cognitive Screening Tool, Mild Cognitive Impairment, Parallel Distributed Processing, Digital Assessment, Convergent Validity.

Authors

Author ORCID Identifier: Mei, Zihan: orcid.org/0000-0002-8552-0034

Affiliation Email addresses: No data is Available

Correspondence Address: Guo, Qihao: Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Department of Gerontology, No. 600, Yi Shan Road, Shanghai, China, 200233, [email protected]

Permissions & Fee and Test Year

Permissions: Contact Corresponding Author

Commercial: No

Fee: No

Test Year: 2023

References

Huang, L., Mei, Z., Ye, J., & Guo, Q. (2023). AMES: An automated self-administered scale to detect incipient cognitive decline in primary care settings. Assessment, 30(7), 2247–2257. doi.org/10.1177/10731911221144774

Items of the Automated Self-Administered Scale (AMES)

The AMES consists of 16 items in total, distributed across four subtests. While the specific content of each item is not provided, the subtests are:

• Guided Learning

• Go no Go

• Number Tabbing

• Delayed Recall

The measure includes 16 items. The test items are not available.