Comparison between two tests of delayed recall for the diagnosis of dementia (original) (raw)
Related papers
PLOS One, 2011
Background: Illiteracy, a universal problem, limits the utilization of the most widely used short cognitive tests. Our objective was to assess and compare the effectiveness and cost for cognitive impairment (CI) and dementia (DEM) screening of three short cognitive tests applicable to illiterates. Methods: Phase III diagnostic test evaluation study was performed during one year in four Primary Care centers, prospectively including individuals with suspicion of CI or DEM. All underwent the Eurotest, Memory Alteration Test (M@T), and Phototest, applied in a balanced manner. Clinical, functional, and cognitive studies were independently performed in a blinded fashion in a Cognitive Behavioral Neurology Unit, and the gold standard diagnosis was established by consensus of expert neurologists on the basis of these results. Effectiveness of tests was assessed as the proportion of correct diagnoses (diagnostic accuracy [DA]) and the kappa index of concordance (k) with respect to gold standard diagnoses. Costs were based on public prices at the time and hospital accounts. Results: The study included 139 individuals: 47 with DEM, 36 with CI, and 56 without CI. No significant differences in effectiveness were found among the tests.
Combined instruments for the screening of dementia in older people with low Education
Arquivos de Neuro-Psiquiatria, 2009
Objective: To determine which combination of cognitive tests and informant reports can improve the diagnostic accuracy of dementia screening in low educated older people. Method: Patients with mild to moderate dementia (n=34) according to ICD-10 and DSM-III-R criteria and 59 older controls were assessed with the Mini-Mental State Examination (MMSE) and the Fuld Object Memory Evaluation (FOME). Informants were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living Scale. Results: The 4 instruments combined with the mixed rule correctly classified 100% and the logistic regression (weighted sum) classified 95.7% of subjects. The weighted sum had a significantly larger ROC area compared to MMSE (p=0.008) and FOME (p=0.023). The specificity of the tested combinations was superior to the MMSE alone (p=0.002). Conclusions: Cognitive tests combined with informant reports can improve the screening of mild to moderate dementia in low educated older people.
Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory
Journal of The International Neuropsychological Society, 2004
Cognitive evaluation in developing countries is a difficult undertaking due to low levels of schooling and particularly the illiteracy still frequent in the elderly. This study was part of the epidemiologic evaluation of dementia in Catanduva, Brazil, and had the objective of comparing the performance of illiterate and literate nondemented elderly individuals in 2 tests of long-term memory-the delayed recall of a word list from the CERAD and the delayed recall of common objects presented as simple drawings from the Brief Cognitive Screening Battery (BCSB). Fifty-one elderly subjects (23 illiterates) were evaluated, and the performance of the illiterates and literates differed in the CERAD memory test, but not in the BCSB memory test. This test may be more suitable for the assessment of long-term memory in populations with a high frequency of illiterates, and therefore might prove to be a useful screening tool for the diagnosis of dementia. (JINS, 2004, 10, 634-638.)
International Journal of Geriatric Psychiatry, 2003
Aim To validate the 'Prueba Cognitiva de Leganés' (PCL) as a screening tool for cognitive impairment in elderly people with little formal education. Methods The PCL is a simple cognitive test with 32 items that includes two scores of orientation and memory and a global score of 0-32 points. It was applied to a population sample of 527 elderly people over 70 with low educational level, who were independently diagnosed by consensus between two neurologists as having normal cognitive function, age associated cognitive decline (AACD, IPA-OMS criteria) or dementia (DSM-IV criteria). Individuals with severe visual or hearing defects and those who rejected the exam were excluded from the study. The PCL was validated in a sample of 375 individuals: 300 normal, 42 with AACD and 33 with dementia. The sensitivity, specificity, accuracy and likelihood ratios, as well as the ROC curves for dementia and for AACD-dementia, were calculated. The confounding effect of sociodemographic variables was assessed by logistic regression analysis and convergent validity by partial correlations of the PCL with other cognitive tests. Inter-rater reliability was evaluated with the intraclass correlation coefficient. Results The PCL identified dementia (cut-off 22) and AACD-dementia (cut-off 26), with the following diagnostic parameters, respectively: sensitivity 93.9%-80%, specificity 94.7%-84.3%, positive likelihood ratio 17.8-5.1, negative likelihood ratio 0.06-0.24, and accuracy 94.6%-83.4%. The areas under the ROC curve were 0.985 (95% Confidence Intervals (CI) 0.967-0.995) and 0.904 (95% CI: 0.870-0.932) respectively. The intraclass correlation coefficient was 0.79 (0.74-0.83). Conclusion The PCL is a simple instrument, which is both valid and reliable, for the screening of dementia in population samples of individuals with low educational level. This instrument could be useful in primary health care.
Analysis of brief language tests in the detection of cognitive decline and dementia
2007
Lexical access difficulties are frequent in normal aging and initial stages of dementia. Verbal fluency tests are valuable to detect cognitive decline, evidencing lexico-semantic and executive dysfunction. Objectives: To establish which language tests can contribute in detecting dementia and to verify schooling influence on subject performance. Method: 74 subjects: 33 controls, 17 Clinical Dementia Rating (CDR) 0.5 and 24 (Brief Cognitive Battery -BCB e Boston Naming Test -BNT) 1 were compared in tests of semantic verbal fluency (animal and fruit), picture naming (BCB and BNT) and the language items of Mini Mental State Examination (MMSE). Results: There were significant differences between the control group and both CDR 0.5 and CDR 1 in all tests. Cut-off scores were: 11 and 10 for animal fluency, 8 for fruit fluency (in both), 8 and 9 for BCB naming. The CDR 0.5 group performed better than the CDR 1 group only in animal fluency. Stepwise multiple regression revealed fruit fluency, animal fluency and BCB naming as the best discriminators between patients and controls (specificity: 93.8%; sensitivity: 91.3%). In controls, comparison between illiterates and literates evidenced schooling influence in all tests, except for fruit fluency and BCB naming. In patients with dementia, only fruit fluency was uninfluenced by schooling. Conclusion: The combination of verbal fluency tests in two semantic categories along with a simple picture naming test is highly sensitive in detecting cognitive decline. Comparison between literate and illiterate subjects shows a lesser degree of influence of schooling on the selected tests, thus improving discrimination between low performance and incipient cognitive decline.
Differentiating illiteracy from Alzheimer's disease by using neuropsychological assessments
International Psychogeriatrics, 2011
ABSTRACTBackground: In Asia, where illiteracy rates are high, determining the degree to which neuropsychological measures can be used to identify cognitive impairment in illiterate elders is important. The aim of this study was to evaluate the effectiveness of using formal neuropsychological assessments to distinguish healthy illiterate elders from dementia patients.Methods: We compared the cognitive performance of healthy elders who were illiterate (illiterate NC, n = 25) with those who were literate (literate NC, n = 25), literate patients with mild Alzheimer's disease (literate AD, n = 25), and illiterate patients with mild AD (illiterate AD, n = 25). Neuropsychological measures included the Mini-Mental State Examination (MMSE), the verbal fluency test, the Boston naming test, the Rosen drawing test, and the verbal learning test.Results: In the between-group analyses, the scores on all tests, except verbal fluency and recognition memory, were lower for illiterate NC compared ...
There has been an increasing trend to utilize short cognitive batteries for the diagnosis of dementia. Most of these batteries have been designed in countries with high standards of education and are less suitable for populations with low levels of education. We developed a battery that has been previously shown to be highly accurate in the diagnosis of dementia in individuals with low levels of education. The accuracy of this battery for patients with higher levels of education is unknown. Objectives: To evaluate the accuracy of a brief cognitive battery in the diagnosis of Alzheimer's disease (AD) in subjects with medium and high levels of schooling, and to develop a mathematical model that includes the most discriminative tests. Methods: Seventy-three mildly demented patients with probable AD and 94 control subjects were evaluated. Sixty patients and 60 controls were randomly selected to generate a mathematical model including the most discriminative tests of the battery using logistic regression. The model was back-tested for the remaining sample of patients and controls. Results: Delayed recall, learning and category fluency tests were included in a mathematical model that obtained an area of 0.917 in the ROC curve in the back-testing. Inter-rater reliabilities of these tests were high (kappa>0.8). Conclusions: This model showed a high accuracy for the diagnosis of mild AD in patients with medium and high educational levels. Future studies with more heterogeneously educated individuals are necessary to investigate whether the educational level (number of years at school) should also be included in the model. Bateria cognitiva breve no diagnóstico de doença de Alzheimer em fase leve em indivíduos com escolaridade média ou alta Resumo -Existe crescente tendência de se utilizarem baterias cognitivas breves no diagnóstico de demência. A maioria destas tem sido idealizada em países com altos níveis de escolaridade e é menos adequada para populações com baixa escolaridade. Desenvolvemos uma bateria que tem demonstrado alta acurácia no diagnóstico de demência em indivíduos com baixa escolaridade, mas a acurácia em indivíduos com escolaridade alta ainda não é conhecida. Objetivos: Avaliar a acurácia de uma bateria cognitiva breve no diagnóstico de doença de Alzheimer (DA) em indivíduos com escolaridade média ou alta, e desenvolver um modelo matemático que inclua os testes mais discriminativos. Métodos: Setenta e três pacientes com demência leve causada por DA provável e 94 controles foram avaliados com a bateria cognitiva breve. Sessenta pacientes e 60 controles foram selecionados aleatoriamente para gerar um modelo matemático com os testes mais discriminativos, empregando regressão logística. Este modelo foi retro-testado na amostra remanescente de pacientes e controles. Resultados: Os testes de memória tardia, aprendizado e fluência verbal foram incluídos no modelo matemático que obteve área sob a curva ROC de 0,917 no retro-teste. A confiabilidade inter-examinadores destes testes foi alta (kappa>0.8). Conclusões: Este modelo apresentou alta acurácia no diagnóstico de demência leve na DA em sujeitos com escolaridade média ou alta. Novos estudos com população com maior heterogeneidade educacional são necessários para investigar se os anos de escolaridade também devem ser incluídos no modelo. Palavras-chave: doença de Alzheimer, demência, diagnóstico, educação, bateria cognitiva breve, testes neuropsicológicos.
Dementia and geriatric cognitive disorders extra, 2014
Alzheimer's disease (AD) is the most common form of dementia. Neuropsychological assessment of individuals with AD primarily focuses on tests of cortical functioning. However, in clinical practice, the underlying pathologies of dementia are unknown, and a focus on cortical functioning may neglect other domains of cognition, including subcortical and executive functioning. The current study aimed to improve the diagnostic discrimination ability of the Consortium to Establish a Registry for Alzheimer's Disease - Neuropsychological Assessment Battery (CERAD-NAB) by adding three tests of executive functioning and mental speed (Trail Making Tests A and B, S-Words). Logistic regression analyses of 594 normal controls (NC), 326 patients with mild AD and 224 patients with other types of dementia (OD) were carried out, and the area under the curve values were compared to those of CERAD-NAB alone. All comparisons except AD-OD (65.5%) showed excellent classification rates (NC-AD: 92.7%...
La Presse Médicale, 2007
Codex, un test fiable en 3 minutes pour la détection de la démence chez le sujet âgés (étude de validation sur 323 sujets) Contexte > La démence est souvent diagnostiquée au stade modéré ou sévère, ce qui constitue une perte de chance pour les patients. Une détection plus précoce de la démence pourrait être améliorée par des outils faciles à employer en soin primaire. But > Élaborer et valider un test très bref pour la détection de la démence. Méthodes > Étude d'élaboration : chez les patients consécutifs d'une consultation mémoire vus pendant 2 ans, le niveau de l'éducation, les scores et sous-scores du Mini Mental Status Examination (MMSE) et un test d'horloge simplifié (THs) ont été recueillis. Le diagnostic de
Identifying Appropriate Neuropsychological Tests for Uneducated/Illiterate Older Individuals
Journal of The International Neuropsychological Society, 2021
Objectives: We investigated the utility of traditional neuropsychological tests in older uneducated/illiterate individuals without dementia to determine the possibility that they are likely not appropriate for this group. Methods: We assessed the neuropsychological performance of 1122 older adults [≥65 years old; mean age: 74.03 (SD = 5.46); mean education: 4.76 (SD = 2.5) years; women: n = 714], in the context of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population-based study conducted in Greece. Results: We based our analyses on three groups: highfunctioning/cognitively healthy (i.e., without dementia) uneducated/illiterate individuals (n = 80), high-functioning/ cognitively healthy educated/literate individuals (n = 932), and low-functioning/cognitively impaired educated/literate individuals (presumably with dementia; n = 110). We used binary regression analyses with Bonferroni correction to investigate whether test performance differentiated uneducated/illiterate from educated/literate individuals. Models were adjusted for age and sex; raw test scores were the predictor variables. The uneducated/illiterate cohort was at a disadvantage relative to the healthy educated/literate group on all variables but verbal memory recognition and consolidation, congruent motor responses, and phonological fluency clustering (p > .002). Moreover, only word list learning immediate and delayed free recall and delayed cued recall differentiated the high-functioning/cognitively healthy uneducated/illiterate from the low-functioning/cognitively impaired educated/literate group, favoring the former (p's < .002). Conclusions: Our findings suggest that only particular verbal memory test variables are fair in determining whether older uneducated/illiterate individuals have functional/cognitive impairment suggestive of a neurodegenerative process. On all other neuropsychological variables, this cohort was at a disadvantage. Therefore, we highlight the need for identifying appropriate methods of assessment for older uneducated/illiterate individuals.