Response Letter to Drs. Vidal, Villas Boas, Valle, and Fukushima

To the Editor

We thank Dr Vidal and colleagues for their interest in the Picture-based Memory Impairment Screen (PMIS),¹ and welcome the opportunity to provide additional details. We confirm that participants name the pictures when first shown and then again in response to the category cue when looking at the picture. These recognition and controlled learning steps are similar to the Memory Impairment Screen (MIS).² Unlike MIS,² an activity of daily living questionnaire³ was used as an additional interference task to expand PMIS screening to low education or illiterate individuals who could not count backwards. Other culture and education appropriate cognitive tests can be explored as the interference task to extend examination to cognitive domains not assessed by the PMIS. The nature of the test items, optimal cutscores and some of the underlying cognitive processes differ between PMIS and MIS.¹ Hence, while the PMIS is based on the MIS, these two tests are not identical or interchangeable in the context of research studies. The PMIS pictures were chosen from a locally validated line drawing series.^{1, 4} We agree that the most common item in a category should be avoided to minimize chances of a correct answer due to guessing. We look forward to seeing more studies of the PMIS in Brazil and elsewhere as well as in other disease populations.

This is a commentary on article Vidal EI, Villas Boas PJ, Valle AP, Fukushima FB. Picture-based memory impairment screen: a major achievement for cognitive assessment of older adults in developing countries. J Am Geriatr Soc. 2013;61(7):1248-9.