The MOST in Brief
Mitchell Clionsky, Ph.D (ABPP-CN) and Emily Clionsky, M.D.
General Description: The Memory Orientation Screening Test is a short, easy to administer, highly reliable, and valid measure of cognitive functioning for older patients.

Based on 25 years of clinical experience, the MOST has been developed and validated using 10 years of neuropsychological data from more than 1500 patients. It has been used successfully in a large outpatient neuropsychology practice and a specialized geripsychiatry practice. The MOST improves the diagnostic capability of clinicians who, until now, have used instruments like the Mini-Mental State Exam to identify dementia.

Pivotal Study: Clionsky, M and Clionsky, E, “Development and Validation of the Memory Orientation Screening Test (MOST™) a better screening test for dementia,” American Journal of Alzheimer’s Disease and Other Dementias. 2010 Dec;25(8);650-6. doi: 10.1177/1533317510386216.

Components: The MOST is an integrated composite of four brief tests of memory and executive function, the major problems of patients with dementia or cognitive loss. These include:

Memory (for three words)

Orientation (to year, season, month, date, day and time)

Sequential memory (for a list of 12 common objects)

Time (organization and abstraction on a predrawn clock face outline).

Administration: The MOST requires only a scoring sheet, a pencil, and 12 standardized color drawings of common household objects and is suitable for computerized administration. In manual administration, the score sheet becomes a permanent record in the patient’s chart. Scoring does not require a calculator or any statistical knowledge. The average clinical administration time is 4½ minutes for patients with mild to moderate dementia.

Scoring and Interpretation: The four components produce a summary score ranging from 0 to 29. Based on the score, a patient can be reliably categorized as having Dementia, Mild Cognitive Impairment, or Normal Cognition. 

Key Features:

Brief administration: Administered and scored in five minutes or less, on paper or using the iPAD, in  approximately half the time of the MMSE.

High patient tolerance: More than 90% of dementia patients complete the MOST. Patients who are blind are not able to identify the visual stimuli or complete the clock drawing test.

Easy to learn: All levels of provders are capable of using the MOST with patients at all levels of cognitive ability in a variety of settings. Medical assistants, administrative staff, physicians and extenders, nurses, psychologists, and respiratory, physical, occupational, speech therapists  and clinicians at other levels of training are successfully trained in less than one hour.

Excellent scoring reliability: Correlations between raters exceed r =.90, allowing for confidence in accuracy of score.

Stable scores across time: Test-retest reliability r=.90 (p<.001) for dementia patients over  2 month period and 9 month intervals.

High correlation with accepted standards: MOST correlates r=.81 with MMSE, indicating 64% shared variance and reflecting a shared common construct of dementia. Yet, this correlation is low enough to reflect the unique contribution of the MOST. In addition, the MOST correlates highly with six standardized neuropsychological tests of memory and executive functioning.

High correlation with dementia severity: MOST correlates r=.80 (p<.0001) with severity of cognitive impairment.

Outperforms other tests: The MOST has a significantly higher correlation with dementia severity and with standardized memory tests than either the Mini Mental State Exam or the Mini-Cog. 

High sensitivity and specificity: ROC demonstrates statistically significant superiority of MOST relative to both MMSE and Mini-Cog (see figure below). It has a sensitivity of 85-89% and a specificity of 76-87%, correctly classifying 83-89% of patients. These levels are significantly higher than either of the other instruments. In addition, when patients with moderate to severe dementia are removed from the evaluation because obviously advanced dementia does not require screening, the MOST is twice as effective than the MMSE in identifying patients who are experiencing dementia. This target population of patients deserves increased attention and initiation of treatment.

Useful: The MOST quickly and reliably identifies patients with MCI or dementia, improves case finding and accuracy of billing for case complexity and allows providers and researchers to track disease severity over time, . The MOST satisfies meaningful use compliance in the Annual Wellness Visit,  Welcome to Medicare visits, and, problem-focused visits in primary care, as well as meeting the specific concerns for cognitive assessment and treatment in orthopedics, cardiac surgery, urology, psychiatry, and, sleep medicine,. Specialized applications for rehabilitation and pharmaceutical research  are available. .  

International and cultural neutrality: The MOST has been translated into Spanish. We are presently inviting partners to participate in validation studies in Europe, South America and Asia. The MOST was specifically designed for low cultural loading. 

Availability: The MOST is now available in paper-format, and on the iPAD through the App Store or on iTunes. Quantity pricing is available. Contract pricing is offered to large medical groups, hospital systems, pharmaceutical companies, home health agencies, benefits management  and insurance companies.

Support: Training and support is available through Internet contact,  via telephone conference and Powerpoint presentations. On-site training and train-the-trainer packages are available. Corporate contracts are application dependent.