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Updated: Mar 6, 2026

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease
Published on: October 13, 2016
[New predictors in prodromal Alzheimer: Deferred phase in word recall of MIS test]
Edith Labos1, Sofía Trojanowski, Marcelo Schapira
1Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires. elabos@arnet.com.ar.
Background:
The Memory Impairment Screen (MIS-A) is a validated test to detect Alzheimer's Disease (AD) and other dementias. We have modified this test to suit a Spanish speaking population and added a new component, delayed recall (MIS-D).
Objectives:
1) To test a Spanish version of MIS-A and MIS-D. 2) To assess the discriminative validity of MIS-D as a screening tool for the amnestic variant of Mild Cognitive Impairment (aMCI).
Methods:
A case-control study of a cohort of 739 aged 65 years old and over, of whom 436 were healthy controls and 303 had a diagnosis of aMCI. The MCI group was patients from the Geriatric Unit for the Elderly at the Italian Hospital of Buenos Aires staffed by geriatricians.
Measurements:
ANOVA test and test t de Student mean comparison. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NVP) were estimated for MIS-D and MIS-A.
Results:
Normative values for MIS-A and MIS-D were obtained from the control population. Both age and education significantly affected these values (p<0.0001). The cut-off for MIS-A should be 7.5 and for MIS-D, 5.5. Comparison between control population and aMCI population using ROC curve gave a result of 5.5 in MIS-D, with 97% specificity and 76% sensitivity.
Conclusion:
MIS-D was positively predictive of Amci. An extension of the sample in other health care contexts would enable us to verify its clinical validity for other populations.
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