Validity of a short computerized assessment battery for moderate cognitive impairment and dementia

2010 ◽  
Vol 22 (5) ◽  
pp. 795-803 ◽  
Author(s):  
Tzvi Dwolatzky ◽  
Luba Dimant ◽  
Ely S. Simon ◽  
Glen M. Doniger
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Discriminant Validity ◽  
Rating Scale ◽  
Cognitive Testing ◽  
Assessment Tools ◽  
Clinical Dementia Rating ◽  
Place Memory ◽  
Visual Spatial ◽  
Moderate Cognitive Impairment

ABSTRACTBackground: Computerized cognitive assessment tools have been developed to make precise neuropsychological assessment readily available to clinicians. Mindstreams batteries for mild impairment have been validated previously. We examined the validity of a Mindstreams battery designed specifically for evaluating those with moderate cognitive impairment.Methods: 170 participants over the age of 60 years performed the computerized battery in addition to standard clinical evaluation. The battery consists of six technician-administered tests and one patient-administered interactive test sampling the cognitive domains of orientation (to time and place), memory, executive function, visual spatial processing, and verbal function. Staging was according to the Clinical Dementia Rating Scale (CDR) on the basis of clinical data but independent of computerized cognitive testing results, thus serving as the gold standard for evaluating the discriminant validity of the computerized measures.Results: Seven participants received a global CDR score of 0 (not impaired), 76 were staged as CDR 0.5 (very mildly impaired), 58 as CDR 1 (mildly impaired), 26 as CDR 2 (moderately impaired), and 3 as CDR 3 (severely impaired). Mindstreams Global Score performance was significantly different across CDR groups (p < 0.001), reflecting poorer overall battery performance for those with greater impairment. This was also true for the domain summary scores, with Executive Function (d = 0.67) and Memory (d = 0.65) distinguishing best between CDR 0.5 and 1, and Orientation best differentiating among CDR 1 and 2 (d = 1.20).Conclusions: The Mindstreams battery for moderate impairment differentiates among varying degrees of cognitive impairment in older adults, providing detailed and distinct cognitive profiles.

scholarly journals The Number Symbol Coding Task: A brief measure of executive function to detect dementia and cognitive impairment

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242233 ◽  
Author(s):  
James E. Galvin ◽  
Magdalena I. Tolea ◽  
Claudia Moore ◽  
Stephanie Chrisphonte
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Problem Solving ◽  
Comprehensive Evaluation ◽  
Clinical Care ◽  
Executive Dysfunction ◽  
Structured Interview ◽  
Assessment Tools ◽  
Quality Data ◽  
Clinical Dementia Rating

Introduction Alzheimer’s disease and related dementias (ADRD) affect over 5.7 million Americans and over 35 million people worldwide. Detection of mild cognitive impairment (MCI) and early ADRD is a challenge to clinicians and researchers. Brief assessment tools frequently emphasize memory impairment, however executive dysfunction may be one of the earliest signs of impairment. To address the need for a brief, easy-to-score, open-access test of executive function for use in clinical practice and research, we created the Number Symbol Coding Task (NSCT). Methods This study analyzed 320 consecutive patient-caregiver dyads who underwent a comprehensive evaluation including the Clinical Dementia Rating (CDR), patient and caregiver versions of the Quick Dementia Rating System (QDRS), caregiver ratings of behavior and function, and neuropsychological testing, with a subset undergoing volumetric magnetic resonance imaging (MRI). Estimates of cognitive reserve were calculated using education, combined indices of education and occupation, and verbal IQ. Psychometric properties of the NSCT including data quality, data distribution, floor and ceiling effects, construct and known-groups validity, discriminability, and clinical profiles were determined. Results The patients had a mean age of 75.3±9.2 years (range 38-98y) with a mean education of 15.7±2.8 years (range 6-26y) of education. The patients had a mean CDR-SB of 4.8±4.7 (range 0–18) and a mean MoCA score of 18.6±7.1 (range 1–30). The mean NSCT score was 30.1±13.8 and followed a normal distribution. All healthy controls and MCI cases were able to complete the NSCT. The NSCT showed moderate-to-strong correlations with clinical and neuropsychological measures with the strongest association (all p’s < .001) for measures with executive components (e.g., Judgement and Problem Solving box of the CDR, Decision Making and Problem Solving domain of the QDRS, Trailmaking B, and Cognigram Attention and Executive Composite Scores). Women slightly outperformed men, and individuals with lower educational attainment and lower education-occupation indices had lower NSCT scores. Decreasing NSCT scores corresponded to older age, worse cognitive scores, higher CDR sum of boxes scores, worse caregiver ratings of function and behavior, worse patient and informant QDRS ratings, and smaller hippocampal volumes and hippocampal occupancy scores. The NSCT provided excellent discrimination (AUC: .866; 95% CI: .82-.91) with a cut-off score of 36 providing the best combination of sensitivity (0.880) and specificity (0.759). Combining the NSCT with patient QDRS and caregiver QDRS ratings improved discrimination (AUC: .908; 95% CI: .87-.94). Discussion The NSCT is a brief, 90-second executive task that incorporates attention, planning and set-switching that can be completed by individuals into the moderate-to-severe stages of dementia. The NSCT may be a useful tool for dementia screening, case-ascertainment in epidemiological or community-based ADRD studies, and in busy primary care settings where time is limited. Combining the NSCT with a brief structured interview tool such as the QDRS may provide excellent power to detect cognitive impairment. The NSCT performed well in comparison to standardized scales of a comprehensive cognitive neurology evaluation across a wide array of sociodemographic variables in a brief fashion that could facilitate its use in clinical care and research.

scholarly journals Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia

2017 ◽  
Vol 24 (2) ◽  
pp. 176-187 ◽  
Author(s):  
Shanna L. Burke ◽  
Miriam J. Rodriguez ◽  
Warren Barker ◽  
Maria T Greig-Custo ◽  
Monica Rosselli ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Performance ◽  
Entorhinal Cortex ◽  
Rating Scale ◽  
Structural Mri ◽  
Diagnostic Group ◽  
Disease Stage ◽  
Clinical Dementia Rating ◽  
Mild Dementia

AbstractObjectives:The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity.Methods:Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group.Results:Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects.Conclusions:Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018,24, 176–187)

Can the Clinical Dementia Rating Scale Identify Mild Cognitive Impairment and Predict Cognitive and Functional Decline?

2016 ◽  
Vol 41 (5-6) ◽  
pp. 292-302 ◽  
Author(s):  
Claudia Woolf ◽  
Melissa J. Slavin ◽  
Brian Draper ◽  
Floortje Thomassen ◽  
Nicole A. Kochan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Rating Scale ◽  
Functional Decline ◽  
High Specificity ◽  
Cognitive Change ◽  
Functional Change ◽  
Clinical Dementia Rating ◽  
Dementia Rating Scale ◽  
Low Sensitivity

Background: The Clinical Dementia Rating Scale (CDR) is used to rate dementia severity. Its utility in diagnosing mild cognitive impairment (MCI) and its predictive value remain unknown. Aims: The aim of this study was to examine the association between CDR scores and expert MCI diagnosis, and to determine whether baseline CDR scores were predictive of cognitive or functional decline and progression to dementia over 6 years. Methods: At baseline, the sample comprised 733 non-demented participants aged 70-90 years from the longitudinal Sydney Memory and Ageing Study. Global and sum of boxes CDR scores were obtained at baseline. Participants also received comprehensive neuropsychological and functional assessment as well as expert consensus diagnoses at baseline and follow-up. Results: At baseline, CDR scores had high specificity but low sensitivity for broadly defined MCI. The balance of sensitivity and specificity improved for narrowly defined MCI. Longitudinally, all baseline CDR scores predicted functional change and dementia, but CDR scores were not predictive of cognitive change. Conclusion: CDR scores do not correspond well with MCI, except when MCI is narrowly defined, suggesting that the CDR taps into the more severe end of MCI. All CDR scores usefully predict functional decline and incident dementia.

Taking the Time to Assess Cognition in Parkinson’s Disease: The Clock Drawing Test

2021 ◽  
pp. 1-10
Author(s):  
Hemant Srivastava ◽  
Allen Joop ◽  
Raima A. Memon ◽  
Jennifer Pilkington ◽  
Kimberly H. Wood ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Cognitive Assessment ◽  
Epworth Sleepiness Scale ◽  
Cognitive Testing ◽  
Clock Drawing Test ◽  
Clock Drawing ◽  
Drawing Test ◽  
Global Cognition ◽  
Psychomotor Vigilance

Background: Cognitive impairment is common and disabling in Parkinson’s disease (PD). Cognitive testing can be time consuming in the clinical setting. One rapid test to detect cognitive impairment in non-PD populations is the Clock Drawing Test (CDT), which calls upon the brain’s executive and visuospatial abilities to draw a clock designating a certain time. Objective: Test the hypothesis that PD participants would perform worse on CDT compared to controls and that CDT would correlate with other measures of cognition. Methods: This study evaluated two independent CDT scoring systems and differences in CDT performance between PD (N = 97) and control (N = 54) participants using a two-sample t-test. Pearson’s correlations were conducted between the CDT and tests of sleepiness (Epworth Sleepiness Scale) and vigilance (Psychomotor Vigilance Test); executive function (Trails B-A); and global cognition (Montreal Cognitive Assessment). Receiver operating characteristic curves were used to determine cut points on the CDT that identify individuals who need additional cognitive testing. Results: PD participants had worse performance on CDT compared to controls. The CDT was correlated with executive function (Trails B-A) and global cognition (Montreal Cognitive Assessment). The CDT correlated with vigilance (Psychomotor Vigilance Task) only in healthy controls. However, the CDT was not correlated with measures of sleepiness (Epworth Sleepiness Scale) in either group. A cut point of 9 on the Rouleau scale and 18 on the Mendez scale identified PD participants with cognitive impairment. Conclusion: The CDT is a rapid clinical cognitive assessment that is feasible in PD and correlates with other measures of cognition.

scholarly journals Behavioural and Psychological Symptoms in Poststroke Vascular Cognitive Impairment

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Meena Gupta ◽  
Abhijit Dasgupta ◽  
Geeta Anjum Khwaja ◽  
Debashish Chowdhury ◽  
Yogesh Patidar ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Rating Scale ◽  
Psychological Symptoms ◽  
Vascular Cognitive Impairment ◽  
Neuropsychiatric Symptom ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Behavioural And Psychological Symptoms ◽  
Relationship Of ◽  
The Relationship

Background.Behavioural and psychological symptoms of dementia (BPSD) cause significant patient and caregiver morbidity in vascular cognitive impairment (VCI).Objectives. To study and compare the occurrence and severity of BPSD between multi-infarct dementia (MID), subcortical ischaemic vascular disease (SIVD), and strategic infarct subtypes of poststroke VCI and to evaluate the relationship of these symptoms with the severity of cognitive impairment.Methods. Sixty patients with poststroke VCI were classified into MID, SIVD, and strategic infarct subtypes. BPSD were studied by the neuropsychiatric inventory (NPI). The severity of cognitive impairment was evaluated by the clinical dementia rating scale (CDR).Results. 95% of cases had at least one neuropsychiatric symptom, with depression being the commonest, irrespective of subtype or severity of VCI. Strategic infarct patients had the lowest frequency of all symptoms. SIVD showed a higher frequency and severity of apathy and higher total NPI scores, compared to MID. Apathy and appetite disturbances occurred more commonly with increasing CDR scores. The total NPI score correlated positively with the CDR score.Conclusion. Depression was the commonest neuropsychiatric symptom in VCI. The neuropsychiatric profiles of MID and SIVD were similar. The frequency and severity of apathy and the net burden of BPSD increased with increasing cognitive impairment.

Evaluating Mild Cognitive Impairment in Essential Tremor: How Many and Which Neuropsychological Tests?

2018 ◽  
Vol 24 (10) ◽  
pp. 1084-1098 ◽  
Author(s):  
Tess E.K. Cersonsky ◽  
Sarah Morgan ◽  
Sarah Kellner ◽  
Daphne Robakis ◽  
Xinhua Liu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Essential Tremor ◽  
Neuropsychological Tests ◽  
Verbal Learning ◽  
Clinical Dementia Rating ◽  
Cognitive Changes ◽  
Increased Risk ◽  
Prospective Longitudinal

AbstractObjectives:Essential tremor (ET) confers an increased risk for developing both amnestic and non-amnestic mild cognitive impairment (MCI). Yet, the optimal measures for detecting mild cognitive changes in individuals with this movement disorder have not been established. We sought to identify the cognitive domains and specific motor-free neuropsychological tests that are most sensitive to mild deficits in cognition as defined by a Clinical Dementia Rating (CDR) of 0.5, which is generally associated with a clinical diagnosis of MCI.Methods:A total of 196 ET subjects enrolled in a prospective, longitudinal, clinical-pathological study underwent an extensive motor-free neuropsychological test battery and were assigned a CDR score. Logistic regression analyses were performed to identify the neuropsychological tests which best identified individuals with CDR of 0.5 (mild deficits in cognition)versus0 (normal cognition).Results:In regression models, we identified five tests in the domains of Memory and Executive Function which best discriminated subjects with CDR of 0.5versus0 (86.9% model classification accuracy). These tests were the California Verbal Learning Test II Total Recall, Logical Memory II, Verbal-Paired Associates I, Category Switching Fluency, and Color-Word Inhibition.Conclusions:Mild cognitive difficulty among ET subjects is best predicted by combined performance on five measures of memory and executive function. These results inform the nature of cognitive dysfunction in ET and the creation of a brief cognitive battery to assess patients with ET for cognitively driven dysfunction in life that could indicate the presence of MCI. (JINS, 2018,24, 1084–1098)

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