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Updated: Jun 17, 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
Development and validation of a harmonized memory score for multicenter Alzheimer's disease and related dementia
Mark Sanderson-Cimino1, Alden L Gross2, Leslie S Gaynor3,4
1Edward and Pearl Fein Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA. mark.sandersoncimino@ucsf.edu.
Introduction:
List-learning tasks (LLTs) are important for characterizing memory in Alzheimer's disease and related dementias. However, as the Uniform Data Set Neuropsychological Battery (UDS-NB) historically did not require a specific LLT, centers have administered different LLTs. The newest UDS version (v4.0) requires one of two LLTs. To support harmonized UDS memory research, we developed a memory composite incorporating UDS memory tests and multiple LLTs.
Methods:
Item-banking confirmatory factor analysis was applied to develop a memory composite in a diagnostically heterogeneous sample (n = 8716) that completed the UDS-NB and one of five LLTs. Construct validity was evaluated through associations with demographics, disease severity, cognitive tasks, brain volume, amyloid/tau PET positivity, and plasma phosphorylated tau. Analyses were replicated in a racially/ethnically diverse cohort (n = 839).
Results:
Psychometric properties were adequate. Expected associations with demographics and clinical measures within development and validation cohorts supported validity.
Conclusions:
This composite supports memory research across cohorts that administer the UDS and LLTs. A user-friendly UI is freely available to create the score in other datasets.
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