The Attention, Memory & Frontal Abilities Screening Test (AMFAST)
About the AMFAST
Cognitive impairment complicates multiple conditions that occur across the lifespan. Indeed, cognitive deficits are routinely seen in neurologic conditions such as traumatic brain injury (TBI); multiple sclerosis (MS); Parkinson’s disease (PD); psychiatric illnesses such as schizophrenia and unipolar and bipolar depression; attention-deficit/hyperactivity disorder (ADHD) and systemic diseases such as systemic lupus erythematosus (SLE), sickle cell disease (SCD) and human immunodeficiency virus (HIV).
Although different underlying neuroanatomic mechanisms are thought to be at play in these discrete disorders, they all have been associated with disturbances that either directly or indirectly impact the functional integrity of frontal-subcortical brain circuits. Moreover, multiple medications and treatments, including certain chemotherapies and focused brain radiation, are also known to affect these frontal-subcortical circuits.
The cognitive dysfunction associated with these conditions is often characterized by a distinct pattern of deficits, typically in attention, processing speed, memory and/or executive functioning (EF).
Multiple tests have been developed to screen for cognitive impairment. These measures are brief (20 minutes or less) and contain items sampling a wide range of cognitive domains. Many of these measures were originally developed to screen specifically for dementia, and consequently place more emphasis on memory and less on other areas of cognitive functioning, such as processing speed and executive functioning.
Furthermore, most screening tests were created to assess functioning in adults only. Given that many of the aforementioned conditions characterized by frontal-subcortical dysfunction (e.g. SLE, SCD, ADHD and leukemia) are also present in children and adolescents, there are clinical indications for a cognitive screener that specifically evaluates deficits in attention, processing speed, memory and executive functioning and can be administered to individuals across the lifespan.
Enter the Attention, Memory and Frontal Abilities Screening Test (AMFAST). The AMFAST is a novel, paper-and-pencil screening test specifically designed to assess for the presence of attention, processing speed, memory and/or executive functioning deficits in individuals age 8 and older.
The AMFAST takes only 10 minutes to administer and is easy to score. It comprises six subtests (see table below): three attention/executive functioning tasks and three memory tasks. The total score is calculated by summing up the scores of the six subtests, with a maximum of 100 points.
AMFAST Subtests
Number Cancelation Test
A timed divided attention/cancellation task in which examinees are instructed to draw a slash through all the 2s and 4s in a series of written numbers as quickly and accurately as possible.
Subtest points: 20
List Memory Test
A word-list learning and recall task involving the presentation of five words over two trials.
Subtest points: 15
Number Letter Switching Test
A timed set-shifting/mental flexibility task in which examinees are required to alternate between saying numbers and letters aloud in numerical and alphabetical order.
Subtest points: 20
Spatial Memory Test
A figure reproduction and recall task in which examinees are required to copy and later reproduce (free recall) a figure that has five details/elements.
Subtest points: 15
Number Inhibition Test
An auditory attention/response inhibition task in which examinees are provided a sheet of paper with four numbered circles and are instructed to tap the number four when the examiner says two, tap two when the examiner says four, and not tap when the examiner says one or three.
Subtest points: 15
Story Memory Test
A story/prose learning and recall task involving the presentation of a short story (read aloud once) that is comprised of seven main details.
Subtest points: 15
AMFAST Download & Instructions
1. Print out the AMFAST Response Page (for examinees). Fold along the dotted line and place in front of the examinee (top half facing up).
2. Print out AMFAST Scoring and Instructions (for examiners). Please note that there are separate Scoring and Instructions for 8-10-year-old examinees. There is also a Spanish translation of the AMFAST.
3. Administer and score the AMFAST according to instructions provided in the AMFAST Scoring and Instructions.
4. Print out the AMFAST Scoring Template on transparency film (optional) to assist in scoring.
5. Interpret the AMFAST according to the guidelines outlined below.
AMFAST Scoring & Interpretation
The total AMFAST score is calculated by summing up the scores of the six subtests, with a maximum of 100 points:
Total Score = Sum of Subtest Scores - Interference Score
Interpretation:
- A total score of 71-83 suggests mild neurocognitive dysfunction.
- The mean total score for healthy control subjects is 88.38 (SD = 6.93).
References
1 Freilich BM, Feirsen N, Welton EI, Mowrey WB, & Rubinstein TB (2020). Validation of the Attention, Memory, and Frontal Abilities Screening Test (AMFAST). Assessment, 27(7), 1502-1514.
2 Yaffe B, Feirsen N, & Freilich BM (2020). The Attention, Memory, and Frontal Abilities Test (AMFAST): A Clinical Efficacy Study in a Sample of Children, Adolescents, and Young Adults with Complex Medical Conditions. Poster presented at the International Neuropsychological Society 48th Annual Meeting, Denver, CO.