Diagnostic Accuracy of Usual Cognitive Screening Tests Versus Appropriate Tests for Lower Education to Identify Alzheimer Disease

2020 ◽  
pp. 089198872095854
Author(s):  
Luciane Viola Ortega ◽  
Ivan Aprahamian ◽  
José Eduardo Martinelli ◽  
Mário Amore Cecchini ◽  
João de Castilho Cação ◽  
...  
Keyword(s):  
Older Adults ◽  
Diagnostic Accuracy ◽  
Clinical Sample ◽  
Memory Test ◽  
Reading Test ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Clock Drawing Test ◽  
Black And White ◽  
Colored Figure

Introduction: The accuracy of commonly used screening tests for Alzheimer’s disease (AD) has not been directly compared to those that could be more appropriate for lower schooling. Objective: To compare the diagnostic accuracy of usual screening tests for AD with instruments that might be more appropriate for lower schooling among older adults with low or no literacy. Methods: The study included a clinical sample of 117 elderly outpatients from a Geriatric Clinic classified as literate controls (n = 39), illiterate controls (n = 30), literate AD (n = 30) and illiterate AD (n = 18). The tests were compared as follows: Black and White versus Colored Figure Memory Test; Clock Drawing Test versus Clock Reading Test; Verbal Fluency (VF) animal versus grocery category; CERAD Constructional Praxis versus Stick Design Test. Results: The means of literate and illiterate controls did not differ in the Black and White Figure Memory Test (immediate recall), Colored Figure Memory Test (delayed recall), Clock Reading Test and VF animals and grocery categories. The means of the clinical groups (controls versus AD), in the 2 schooling levels, differed significantly in most of the tests, except for the CERAD Constructive Praxis and the Stick Design Test. Diagnostic accuracy was not significantly different between the compared tests. Conclusion: Commonly used screening tests for AD were as accurate as those expected to overcome the education bias in a sample of older adults with lower or no education.

scholarly journals Performance-based instrument to assess functional capacity in community-dwelling older adults

2019 ◽  
Vol 13 (4) ◽  
pp. 386-393
Author(s):  
Ana Cláudia Becattini-Oliveira ◽  
Leonardo Cardoso Portela Câmara ◽  
Douglas de Farias Dutra ◽  
Antonia de Azevedo Falcão Sigrist ◽  
Helenice Charchat-Fichman
Keyword(s):  
Older Adults ◽  
Functional Capacity ◽  
Independent Living ◽  
Community Dwelling ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Clock Drawing Test ◽  
Neuropsychological Functions ◽  
Figure Test ◽  
Community Dwelling Older Adults

ABSTRACT Functional capacity (FC) is a mediator between neuropsychological functions and real-world functioning, but there is a lack of evidence of its correlation in community-dwelling older adults. Objective: The study aim was to determine the FC level of community-dwelling older adults using the UCSD Performance-based Skills Assessment (UPSA) and to evaluate correlation with cognitive screening tests. Methods: Senior center participants were selected according to inclusion criteria: Portuguese fluency, age ≥60 years and self-reported independent living. The subject exclusion criteria were: dementia or other DSM-5 diagnoses, suicidal ideation or intent, non-completion of assessment battery, enrollment in another psychosocial intervention or pharmacotherapy study. FC level was determined by the UPSA, brief UPSA (UPSA-B) and Instrumental Activities of Daily Living scale (IADL’s). The Mini-Mental State Examination (MMSE), Memory of Figure Test (MFT), Verbal Fluency Test (VFT) and Clock Drawing Test (CDT) were used for cognitive assessment. A total of 35 subjects that had a mean age of 72 years, were predominantly females(88.6%) and had mean education level of 11.25 years were evaluated. Results: Mean UPSA and UPSA-B scores were 78.5 and 70, respectively. A statistically significant correlation was observed between the UPSA and IADL, MMSE and VFT. Conclusion: The UPSA serves as a screening assessment of FC in community-dwelling older adults, showing a positive correlation with cognitive screening tests.

scholarly journals Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review

2019 ◽  
Vol 77 (4) ◽  
pp. 279-288 ◽  
Author(s):  
Luciane de Fátima Viola Ortega ◽  
Ivan Aprahamian ◽  
Marcus Kiiti Borges ◽  
João de Castilho Cação ◽  
Mônica Sanches Yassuda
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Diagnostic Accuracy ◽  
Screening Tools ◽  
Screening Tests ◽  
Screening Instruments ◽  
Cognitive Screening ◽  
Inclusion Criteria ◽  
Low Education ◽  
Low Educated

ABSTRACT Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). Objective: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. Methods: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. Results: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. Conclusion: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.

Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis

2017 ◽  
Vol 29 (6) ◽  
pp. 897-929 ◽  
Author(s):  
Stella-Maria Paddick ◽  
William K. Gray ◽  
Jackie McGuire ◽  
Jenny Richardson ◽  
Catherine Dotchin ◽  
...  
Keyword(s):  
Older Adults ◽  
Validation Studies ◽  
Meta Analysis ◽  
Significant Proportion ◽  
Educational Background ◽  
Screening Tools ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Low Literacy ◽  
Prevalence Studies

ABSTRACTBackground:The majority of older adults with dementia live in low- and middle-income countries (LMICs). Illiteracy and low educational background are common in older LMIC populations, particularly in rural areas, and cognitive screening tools developed for this setting must reflect this. This study aimed to review published validation studies of cognitive screening tools for dementia in low-literacy settings in order to determine the most appropriate tools for use.Method:A systematic search of major databases was conducted according to PRISMA guidelines. Validation studies of brief cognitive screening tests including illiterate participants or those with elementary education were eligible. Studies were quality assessed using the QUADAS-2 tool. Good or fair quality studies were included in a bivariate random-effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) curve constructed.Results:Forty-five eligible studies were quality assessed. A significant proportion utilized a case–control design, resulting in spectrum bias. The area under the ROC (AUROC) curve was 0.937 for community/low prevalence studies, 0.881 for clinic based/higher prevalence studies, and 0.869 for illiterate populations. For the Mini-Mental State Examination (MMSE) (and adaptations), the AUROC curve was 0.853.Conclusion:Numerous tools for assessment of cognitive impairment in low-literacy settings have been developed, and tools developed for use in high-income countries have also been validated in low-literacy settings. Most tools have been inadequately validated, with only MMSE, cognitive abilities screening instrument (CASI), Eurotest, and Fototest having more than one published good or fair quality study in an illiterate or low-literate setting. At present no screening test can be recommended.

scholarly journals The use of the Clock Drawing Test in bipolar disorder with or without dementia of Alzheimer’s type

2014 ◽  
Vol 72 (12) ◽  
pp. 913-918 ◽  
Author(s):  
Ivan Aprahamian ◽  
Marcia Radanovic ◽  
Paula Villela Nunes ◽  
Rodolfo Braga Ladeira ◽  
Orestes Vicente Forlenza
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Screening Tests ◽  
Elderly Subjects ◽  
Limited Data ◽  
Clock Drawing Test ◽  
Clock Drawing ◽  
Drawing Test ◽  
Dementia Of Alzheimer’S Type ◽  
State Examination

There is limited data regarding the cognitive profile from screening tests of older adults with bipolar disorder (BD) with dementia. Objective To investigate the Clock Drawing Test (CDT) among older adults with BD with and without Alzheimer’s disease (AD). Method 209 older adults (79 with BD without dementia and 70 controls; 60 with AD, being 27 with BD) were included to evaluate the performance of three CDT scoring scales, beyond the Mini-Mental State Examination (MMSE) and verbal fluency (VFT). Results Patients with BD without dementia presented with lower scores in MMSE, VF and one CDT scoring scale than controls. Patients with BD and AD presented with lower scores in VF and CDT scoring scales than patients with only AD. All CDT scales presented similar sensitivity and specificity for BD and non-BD groups. Conclusion Elderly subjects with BD showed greater impairment in CDT in both groups of normal cognition and AD.

Prospective comparison of two cognitive screening tests: diagnostic accuracy and correlation with community integration and quality of life

2011 ◽  
Vol 105 (2) ◽  
pp. 337-344 ◽  
Author(s):  
Robert A. Olson ◽  
Grant L. Iverson ◽  
Hannah Carolan ◽  
Maureen Parkinson ◽  
Brian L. Brooks ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diagnostic Accuracy ◽  
Community Integration ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Prospective Comparison

scholarly journals ACCURACY OF FIGURE MEMORY TEST OF THE BRIEF COGNITIVE SCREENING BATTERY TO PREDICT AMYLOID STATUS IN OLDER ADULTS WITH SUBJECTIVE COGNITIVE DECLINE

2021 ◽  
Author(s):  
Adalberto Studart-Neto ◽  
Artur Coutinho ◽  
Camila Carneiro ◽  
Natália Moraes ◽  
Mateus Aranha ◽  
...  
Keyword(s):  
Older Adults ◽  
Area Under The Curve ◽  
Memory Test ◽  
Subjective Cognitive Decline ◽  
Amyloid Pet ◽  
Cognitive Screening ◽  
Delayed Recall ◽  
Complex Figure ◽  
Screening Battery ◽  
Significant Area

Background: Some older adults with subjective decline (SCD) had a positive amyloid biomarker indicating a preclinical stage of Alzheimer’s disease. Objectives: To assess the accuracy of Delayed Recall of Figure Memory Test (DR-FMT) of Brief Cognitive Screening Battery to predict amyloid status in SCD older adults. Objective: To assess the accuracy of Delayed Recall of Figure Memory Test (DR-FMT) of Brief Cognitive Screening Battery to predict amyloid status in SCD older adults. Methods: The sample consisted of 45 older adults classified as SCD and 25 as controls without complaints (mean age of 76.4 and 73.5, respectively, p= 0.138). They were evaluated with BCSB and a standard neuropsychological battery (which includes MMSE, MoCA, RAVLT, Logical Memory and DR of Rey Complex Figure). Subjects underwent PIB-PET to assess their amyloid status and images were classified based on visual and semi-quantitative analyses with 3DSSP methodology. Results: Twelve SCD older adults (27.3%) had positive PIB-PET against six in the controls (23.1%). In SCD group, DR-FMT was the only memory test that correlated with SUV in amyloid PET (r = -0.514, p < 0.001). Only DR-FMT showed significant area under the curve (AUC) in the ROC curve in SCD older adults (AUC = 0.771, 95% CI 0.621 - 0.921). Among SCD older adults, DR-FMT < 8.0 had a sensitivity of 83.3%, a specificity of 68.7% and an accuracy of 72.7%. Conclusion: FMT proved to have a good sensitivity and accuracy to predict amyloid status in SCD older adults.

scholarly journals Qualitative analysis of the Clock Drawing Test by educational level and cognitive profile

2014 ◽  
Vol 72 (4) ◽  
pp. 289-295 ◽  
Author(s):  
Aline Teixeira Fabricio ◽  
Ivan Aprahamian ◽  
Mônica Sanches Yassuda
Keyword(s):  
Qualitative Analysis ◽  
Educational Level ◽  
Age Groups ◽  
Cognitive Profile ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Cognitive Changes ◽  
Clock Drawing Test ◽  
Clock Drawing ◽  
Drawing Test

The use of a qualitative scale for the Clock Drawing Test (CDT) may add information about the pattern of errors committed. Objective: To translate and adapt the Modified Qualitative Error Analysis of Rouleau into Brazilian Portuguese and to examine the pattern of errors according to educational level and cognitive profile. Method: 180 adults (47-82 years) completed the CDT. Participants were stratified into age and educational levels and separated between those with and without changes in cognitive screening tests (Mini-Mental State Examination, Verbal Fluency). Results: No significant differences were found in CDT scores among age groups. Among participants without cognitive impairment, those with lower education often presented graphic difficulties, conceptual deficits and spatial deficits. Participants with cognitive deficits, demonstrated more frequently conceptual and spatial errors. Conclusion: The qualitative analysis of the CDT may contribute to the identification of cognitive changes. Education level has to be taken into consideration during the analysis.

[P3-446]: DIAGNOSTIC ACCURACY FOR ALZHEIMER DISEASE OF A SET OF COGNITIVE SCREENING TESTS APPROPRIATE FOR LOW EDUCATION

2017 ◽  
Vol 13 (7S_Part_23) ◽  
pp. P1140-P1141
Author(s):  
Luciane de Fátima Viola Ortega ◽  
Anelize de Carvalho Ferreira ◽  
Luana Colturato Dalul ◽  
Ana Carolina Garcia e Garcia ◽  
Silvia Aparecida Soares ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Diagnostic Accuracy ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Low Education

scholarly journals Triple Test Plus Rapid Cognitive Screening Test: A Combination of Clinical Signs and A Tool for Cognitive Assessment in Older Adults

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 97 ◽  
Author(s):  
Saadet Koc Okudur ◽  
Ozge Dokuzlar ◽  
Derya Kaya ◽  
Pinar Soysal ◽  
Ahmet Turan Isik
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Head Turning ◽  
Predictive Values ◽  
Triple Test ◽  
Cognitive Screen

Less time-consuming, easy-to-apply and more reliable cognitive screening tests are essential for use in primary care. The aim of this study was to investigate the diagnostic value of the Turkish version of the Rapid Cognitive Screen (RCS-T) and Triple Test individually and the combination of RCS-T with each sign and Triple Test to screen elderly patients for cognitive impairment (CI). A total of 357 outpatients aged 60 or older, who underwent comprehensive geriatric assessment, were included in the study. Presence or absence of attended alone sign (AAS), head-turning sign, and applause sign was investigated. The mean age of the patients was 74.29 ± 7.46. Of those, 61 patients (28 men, 33 women) had Alzheimer’s disease (AD), 59 patients had mild cognitive impairment (MCI) (29 men, 30 women), and 237 (80 men, 157 women) were cognitively robust. The sensitivity of the combination of RCS-T and negative for AAS for CI, AD and MCI is 0.79, 0.86 and 0.61, respectively; the specificity was 0.92, 0.93 and 0.92, respectively; and the positive and negative predictive values revealed good diagnostic accuracy. The combination of RCS-T and negative for AAS is a simple, effective and rapid way to identify possible CI in older adults.

scholarly journals Effect of Reduced Audibility on Mini-Mental State Examination Scores

2019 ◽  
Vol 30 (10) ◽  
pp. 845-855
Author(s):  
Laura Gaeta ◽  
Jo Azzarello ◽  
Jonathan Baldwin ◽  
Carrie A. Ciro ◽  
Mary A. Hudson ◽  
...  
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Hearing Loss ◽  
Signal To Noise Ratio ◽  
Normal Hearing ◽  
Cognitive Status ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Matched Case ◽  
State Examination

AbstractThe interaction of audition and cognition has been of interest to researchers and clinicians, especially as the prevalence of hearing loss and cognitive decline increases with advancing age. Cognitive screening tests are commonly used to assess cognitive status in individuals reporting changes in memory or function or to monitor cognitive status over time. These assessments are administered verbally, so performance may be adversely affected by hearing loss. Previous research on the impact of reduced audibility on cognitive screening test scores has been limited to older adults with sensorineural hearing loss (SNHL) or young adults with normal hearing and simulated audibility loss. No comparisons have been conducted to determine whether age-related SNHL and its impact on cognitive screening tests is successfully modeled by audibility reduction.The purpose of this study was to examine the effects of reduced audibility on the Mini-Mental State Examination (MMSE), a common bedside cognitive screening instrument, by comparing performance of cognitively normal older adults with SNHL and young adults with normal hearing.A 1:1 gender-matched case–control design was used for this study.Thirty older adults (60–80 years old) with mild to moderately severe SNHL (cases) and 30 young adults (18–35 years old) with normal hearing (controls) served as participants for this study. Participants in both groups were selected for inclusion if their cognitive status was within normal limits on the Montreal Cognitive Assessment.Case participants were administered a recorded version of the MMSE in background noise at a signal-to-noise ratio of +25-dB SNR. Control participants were administered a digitally filtered version of the MMSE that reflected the loss of audibility (i.e., threshold elevation) of the matched case participant at a signal-to-noise ratio of +25-dB SNR. Performance on the MMSE was scored using standard criteria.Between-group analyses revealed no significant difference in the MMSE score. However, within-group analyses showed that education was a significant effect modifier for the case participants.Reduced audibility has a negative effect on MMSE score in cognitively intact participants, which contributes to and confirms the findings of earlier studies. The findings suggest that observed reductions in score on the MMSE were primarily due to loss of audibility of the test item. The negative effects of audibility loss may be greater in individuals who have lower levels of educational attainment. Higher levels of educational attainment may offset decreased performance on the MMSE because of reduced audibility. Failure to consider audibility and optimize communication when administering these assessments can lead to invalid results (e.g., false positives or missed information), misdiagnosis, and inappropriate recommendations for medication or intervention.

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