Introduction: Cognitive function prior to mild cognitive impairment (MCI) has become a burgeoning interest. Tools used to detect this early period before MCI are being pilot-tested. This study aimed to develop a new test to detect pre-MCI and to examine its content validity and feasibility. Methods: The Story Telling Examination for Early MCI Screening (STEEMS), an audio cognitive test, was developed. It covers ten cognitive domains, e.g., executive function, language fluency, abstract reasoning. Face and content validity were examined by experts in geriatric psychiatry and psychology. The content validity index was 1.00. STEEMS comprised 12 items with 2–4 types of scoring. The tool was further examined in 16 pilot samples for feasibility among healthy participants having no cognitive impairment (Montreal Cognitive Assessment [MoCA] test score ≥25, Mini-Cog ≥3) and no depressive symptoms (Geriatric Depression Scale <6). Results: The 16 healthy older individuals aged 59–73 years, mean age was 65.06 ± 4.07 years, were predominantly males (68.8%). STEEMS scores ranged from 10 to 25, with a mean of 18.38 (SD = 4.2). Thirteen percent obtained 100% correct on the STEEMS, 63% scored 68–92% correct, and 25% scored 40–60% correct. The pre-MCI scores are illustrated by a bell curve’s graphical depiction, suggesting a normal distribution probability distribution. Correlation between STEEMS and MoCA test scores was observed. STEEMS showed to be feasible for early elderly or late adults as being brief and easy to understand. The time spent to administer was predictably less than 7 min. Discussion/Conclusion: STEEMS could potentially serve as a tool for pre-MCI screening. Further study and investigation in a larger population are required.

Wang Y, Song M, Yu L, Wang L, An C, Xun S, et al. Mild cognitive impairment: vascular risk factors in community elderly in four cities of Hebei Province, China. PLoS One. 2015;10(5):e0124566.
Thomas KR, Edmonds EC, Eppig JS, Wong CG, Weigand AJ, Bangen KJ, et al. MCI-to-normal reversion using neuropsychological criteria in the Alzheimer’s Disease Neuroimaging Initiative. Alzheimers Dement. 2019;15(10):1322–32.
Sachdev PS, Lipnicki DM, Crawford J, Reppermund S, Kochan NA, Trollor JN, et al. Factors predicting reversion from mild cognitive impairment to normal cognitive functioning: a population-based study. PLoS One. 2013;8(3):e59649.
Pandya SY, Lacritz LH, Weiner MF, Deschner M, Woon FL. Predictors of reversion from mild cognitive impairment to normal cognition. Dement Geriatr Cogn Disord. 2017;43(3–4):204–14.
Duara R, Loewenstein DA, Greig MT, Potter E, Barker W, Raj A, et al. Pre-MCI and MCI: neuropsychological, clinical, and imaging features and progression rates. Am J Geriatr Psychiatry. 2011;19(11):951–60.
Storandt M, Grant EA, Miller JP, Morris JC. Longitudinal course and neuropathologic outcomes in original vs. revised MCI and in pre-MCI. Neurology. 2006;67(3):467–73.
Jessen F, Amariglio RE, Buckley RF, van der Flier WM, Han Y, Molinuevo JL, et al. The characterisation of subjective cognitive decline. Lancet Neurol. 2020;19(3):271–8.
Seo EH, Kim H, Lee KH, Choo IH. Altered executive function in pre-mild cognitive impairment. J Alzheimers Dis. 2016;54(3):933–40.
Hendrix SB. Measuring clinical progression in MCI and pre-MCI populations: enrichment and optimizing clinical outcomes over time. Alzheimers Res Ther. 2012;4:24.
Crocco EA, Loewenstein DA, Curiel RE, Alperin N, Czaja SJ, Harvey PD, et al. A novel cognitive assessment paradigm to detect Pre-mild cognitive impairment (PreMCI) and the relationship to biological markers of Alzheimer’s disease. J Psychiatr Res. 2018;96:33–8.
Tsoi KKF, Chan JYC, Hirai HW, Wong A, Mok VCT, Lam LCW, et al. Recall tests are effective to detect mild cognitive impairment: a systematic review and meta-analysis of 108 diagnostic studies. J Am Med Dir Assoc. 2017;18(9):807.e17–807.e29.
Kirova AM, Bays RB, Lagalwar S. Working memory and executive function decline across normal aging, mild cognitive impairment, and Alzheimer’s disease. Biomed Res Int. 2015;2015:748212.
Darby DG, Fredrickson J, Pietrzak RH, Maruff P, Woodward M, Brodtmann A. Reliability and usability of an internet-based computerized cognitive testing battery in community-dwelling older people. Comput Hum Behav. 2014;30:199–205.
Fredrickson J, Maruff P, Woodward M, Moore L, Fredrickson A, Sach J, et al. Evaluation of the usability of a brief computerized cognitive screening test in older people for epidemiological studies. Neuroepidemiology. 2010;34(2):65–75.
Hall B. The financing of research and development. 2002.
Burton RR. Guidelines for a research and development (R&D) program for high sustained G. Physiologist. 1993;36(Suppl l):S94–7.
Yusoff MSB. ABC of content validation and content validity index calculation. Education Med J. 2019;11(2):49–54.
Cocks K, Torgerson DJ. Sample size calculations for pilot randomized trials: a confidence interval approach. J Clin Epidemiol. 2013;66(2):197–201.
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.
Tangwongchai S, Phanasathit M, Charernboon T, Akkayagorn L, Hemrungrojn S, Phanthumchinda K, et al. The validity of thai version of the montreal cognitive assessment (MoCA-T). Dement Neuropsychol. 2009;3:172.
Thai version of Montreal Cognitive Assessment. Available from:
Trongsakul S, Lambert R, Clark A, Wongpakaran N, Cross J. Development of the Thai version of Mini-Cog, a brief cognitive screening test. Geriatr Gerontol Int. 2015;15(5):594–600.
Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15(11):1021–7.
Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37–49.
Wongpakaran N, Wongpakaran T, Van Reekum R. The use of GDS-15 in detecting MDD: a comparison between residents in a Thai long-term care home and geriatric outpatients. J Clin Med Res. 2013;5(2):101–11.
Wongpakaran N, Wongpakaran T, Kuntawong P. Evaluating hierarchical items of the geriatric depression scale through factor analysis and item response theory. Heliyon. 2019;5(8):e02300.
Hemrungrojn S, Tangwongchai S, Charoenboon T, Panasawat M, Supasitthumrong T, Chaipresertsud P, et al. Use of the montreal cognitive assessment Thai version to discriminate amnestic mild cognitive impairment from alzheimer’s disease and healthy controls: machine learning results. Dement Geriatr Cogn Disord. 2021;50(2):183–94.
Eramudugolla R, Huynh K, Zhou S, Amos JG, Anstey KJ. Social cognition and social functioning in MCI and dementia in an epidemiological sample. J Int Neuropsychol Soc. 2021;28(7):661–72.
Ng TP, Feng L, Lim WS, Chong MS, Lee TS, Yap KB, et al. Montreal Cognitive Assessment for screening mild cognitive impairment: variations in test performance and scores by education in Singapore. Dement Geriatr Cogn Disord. 2015;39(3–4):176–85.
You do not currently have access to this content.