Reliability and Feasibility of the Memory Associative Test TMA-93

Background: Memory tests focused on binding may be more sensitive to diagnose Alzheimer's disease (AD) at an early phase. TMA-93 examines relational binding by images. Objective: Evaluate the reliability (internal consistency and inter-rater and test-retest reliability) and feasibility of the TMA-93 in a clinic setting with low-educated individuals and limited face-to-face time per patient. Methods: The study was undertaken in a neurology outpatient clinic of a hospital in Southern Spain. The internal consistency of the TMA-93 was estimated in 35 patients with amnestic mild cognitive impairment (aMCI) and 40 healthy controls (HCs). The inter-rater reliability (by two raters) and feasibility (by recording the percentage of participants who completed the test, and by timing the administration time) were evaluated in HCs (n = 16), aMCI patients (n = 18), and mild dementia patients (n = 15). The test-retest reliability for the TMA-93 total score was studied in 51 HCs tested by the same examiner 2-4 months apart. The internal consistency was estimated by Cronbach's alpha. The inter-rater and test-retest reliability was quantified by the intraclass correlation coefficient (ICC). The administration time was compared by diagnosis. Results: The internal consistency was "optimal" (Cronbach's alpha = 0.936). The test-retest reliability was "good" [ICC = 0.802 (CI 95% = 0.653-0.887)]. The inter-rater reliability was "optimal" [ICC = 0.999, (CI 95% = 0.999-1)]. All participants completed the test. The administration time ranged from less than 3 min in HCs to 6 min in aMCI patients, and 7 min in mild dementia patients. Conclusion: Good feasibility and reliability support using the TMA-93 for examining visual relational binding, particularly in the context of low-educational attainment and limited time per patient.