Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T17:06:15.245Z Has data issue: false hasContentIssue false
  • English
  • Français

Improving the Accuracy and Precision of Cognitive Testing in Mild Dementia

Published online by Cambridge University Press:  30 December 2011

Hans Wouters ,
Bregje Appels ,
Wiesje M. van der Flier ,
Jos van Campen ,
Martin Klein ,
Aeilko H. Zwinderman ,
Ben Schmand ,
Willem A. van Gool ,
Philip Scheltens  and
Robert Lindeboom
Hans Wouters*
Affiliation:
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
Bregje Appels
Affiliation:
Department of Medical Psychology, Slotervaart Hospital, Amsterdam, the Netherlands
Wiesje M. van der Flier
Affiliation:
Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands
Jos van Campen
Affiliation:
Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, the Netherlands
Martin Klein
Affiliation:
Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
Aeilko H. Zwinderman
Affiliation:
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Ben Schmand
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
Willem A. van Gool
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Philip Scheltens
Affiliation:
Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands
Robert Lindeboom
Affiliation:
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
*
Correspondence and reprint requests to: Hans Wouters, Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG, Utrecht, The Netherlands. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The CAMCOG, ADAS-cog, and MMSE, designed to grade global cognitive ability in dementia have inadequate precision and accuracy in distinguishing mild dementia from normal ageing. Adding neuropsychological tests to their scale might improve precision and accuracy in mild dementia. We, therefore, pooled neuropsychological test-batteries from two memory clinics (ns = 135 and 186) with CAMCOG data from a population study and 2 memory clinics (n = 829) and ADAS-cog data from 3 randomized controlled trials (n = 713) to estimate a common dimension of global cognitive ability using Rasch analysis. Item difficulties and individuals’ global cognitive ability levels were estimated. Difficulties of 57 items (of 64) could be validly estimated. Neuropsychological tests were more difficult than the CAMCOG, ADAS-cog, and MMSE items. Most neuropsychological tests had difficulties in the ability range of normal ageing to mild dementia. Higher than average ability levels were more precisely measured when neuropsychological tests were added to the MMSE than when these were measured with the MMSE alone. Diagnostic accuracy in mild dementia was consistently better after adding neuropsychological tests to the MMSE. We conclude that extending dementia specific instruments with neuropsychological tests improves measurement precision and accuracy of cognitive impairment in mild dementia. (JINS, 2012, 18, 314–322)

Keywords

Neuropsychology methodsNeuropsychology classificationDementia diagnosisDementia epidemiologyDementia psychologyCognition disordersPsychometrics methodsModels logistic
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 2 , March 2012 , pp. 314 - 322
Copyright
Copyright © The International Neuropsychological Society 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders, revised third edition. Washington, DC: Author.Google Scholar
De Jager, C.A., Milwain, E., Budge, M. (2002). Early detection of isolated memory deficits in the elderly: The need for more sensitive neuropsychological tests. Psychological Medicine, 32, 483–491.CrossRefGoogle ScholarPubMed
Fischer, G.H., Molenaar, I.W. (1995). Rasch models: Foundations, recent developments and applications. New York: Springer-Verlag.CrossRefGoogle Scholar
Folstein, M.F., Folstein, S.E., McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Frankfort, S.V., Appels, B.A., De Boer, A., Tulner, L.R., Van Campen, J.P., Koks, C.H., Beijnen, J.H. (2006). Treatment effects of rivastigmine on cognition, performance of daily living activities and behaviour in Alzheimer's disease in an outpatient geriatric setting. International Journal of Clinical Practice, 60, 646–654.CrossRefGoogle Scholar
Harrison, J., Minassian, S.L., Jenkins, L., Black, R.S., Koller, M., Grundman, M. (2007). A neuropsychological test battery for use in Alzheimer disease clinical trials. Archives of Neurology, 64, 1323–1329.CrossRefGoogle ScholarPubMed
Hobart, J.C., Cano, S.J., Zajicek, J.P., Thompson, A.J. (2007). Rating scales as outcome measures for clinical trials in neurology: Problems, solutions, and recommendations. Lancet Neurology, 6, 1094–1105.CrossRefGoogle ScholarPubMed
Holman, R., Lindeboom, R., Glas, C.A.W., Vermeulen, M., De Haan, R.J. (2003). Constructing an item bank using Item Response Theory: The AMC linear disability score project. Health Services and Outcomes Research Methodology, 4, 19–33.CrossRefGoogle Scholar
Jenkinson, C., Fitzpatrick, R., Garratt, A., Peto, V., Stewart-Brown, S. (2001). Can item response theory reduce patient burden when measuring health status in neurological disorders? Results from Rasch analysis of the SF-36 physical functioning scale (PF-10). Journal of Neurology, Neurosurgery, and Psychiatry, 71, 220–224.CrossRefGoogle ScholarPubMed
Jonker, C., Schmand, B., Lindeboom, J., Havekes, L.M., Launer, L.J. (1998). Association between apolipoprotein E epsilon4 and the rate of cognitive decline in community-dwelling elderly individuals with and without dementia. Archives of Neurology, 55, 1065–1069.CrossRefGoogle ScholarPubMed
Kelderman, H. (1988). Common item equating: Using the loglinear Rasch model. Journal of Educational Statistics, 13, 319–336.CrossRefGoogle Scholar
Lezak, M.D. (1995). Neuropsychological assessment. New York: Oxford University Press.Google Scholar
Lindeboom, J., Schmand, B., Tulner, L., Walstra, G., Jonker, C. (2002). Visual association test to detect early dementia of the Alzheimer type. Journal of Neurology, Neurosurgery, and Psychiatry, 73, 126–133.CrossRefGoogle ScholarPubMed
McKeith, I.G., Galasko, D., Kosaka, K., Perry, E.K., Dickson, D.W., Hansen, L.A., Perry, R.H. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report of the consortium on DLB international workshop. Neurology, 47, 1113–1124 .CrossRefGoogle Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Meulen, E.F., Schmand, B., Van Campen, J.P., De Koning, S.J., Ponds, R.W., Scheltens, P., Verhey, F.R. (2004). The seven minute screen: A neurocognitive screening test highly sensitive to various types of dementia. Journal of Neurology, Neurosurgery, and Psychiatry, 75, 700–705.CrossRefGoogle ScholarPubMed
Mohs, R.C., Knopman, D., Petersen, R.C., Ferris, S.H., Ernesto, C., Grundman, M., Thal, L.J. (1997). Development of cognitive instruments for use in clinical trials of antidementia drugs: Additions to the Alzheimer's Disease Assessment Scale that broaden its scope. The Alzheimer's Disease Cooperative Study. Alzheimer's Disease and Associated Disorders, 11(Suppl. 2), S13–S21 .CrossRefGoogle Scholar
Mungas, D., Reed, B.R., Kramer, J.H. (2003). Psychometrically matched measures of global cognition, memory, and executive function for assessment of cognitive decline in older persons. Neuropsychology, 17, 380–392.CrossRefGoogle ScholarPubMed
Neary, D., Snowden, J.S., Gustafson, L., Passant, U., Stuss, D., Black, S., Benson, D.F. (1998). Frontotemporal lobar degeneration: A consensus on clinical diagnostic criteria. Neurology, 51, 1546–1554 .CrossRefGoogle ScholarPubMed
Raskind, M.A., Peskind, E.R., Wessel, T., Yuan, W. (2000). Galantamine in AD: A 6-month randomized, placebo-controlled trial with a 6-month extension. The Galantamine USA-1 Study Group. Neurology, 54, 2261–2268.CrossRefGoogle Scholar
Reitan, R.M. (1955). The relation of the trail making test to organic brain damage. Journal of Consulting Psychology, 19, 393–394.CrossRefGoogle ScholarPubMed
Román, G.C., Tatemichi, T.K., Erkinjuntti, T., Cummings, J.L., Masdeu, J.C., Garcia, J.H., Hofman, A. (1993). Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250–260 .CrossRefGoogle ScholarPubMed
Rosen, W.G., Mohs, R.C., Davis, K.L. (1984). A new rating scale for Alzheimer's disease. American Journal of Psychiatry, 141, 1356–1364.Google ScholarPubMed
Roth, M., Tym, E., Mountjoy, C.Q., Huppert, F.A., Hendrie, H., Verma, S., Goddard, R. (1986). CAMDEX. A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698–709.CrossRefGoogle Scholar
Stroop, J.R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643–662.CrossRefGoogle Scholar
Tariot, P.N., Solomon, P.R., Morris, J.C., Kershaw, P., Lilienfeld, S., Ding, C. (2000). A 5-month, randomized, placebo-controlled trial of galantamine in AD. The Galantamine USA-10 Study Group. Neurology, 54, 2269–2276.CrossRefGoogle ScholarPubMed
Tombaugh, T.N., McIntyre, N.J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40, 922–935.CrossRefGoogle ScholarPubMed
Van der Vlies, A.E., Pijnenburg, Y.A., Koene, T., Klein, M., Kok, A., Scheltens, P., van der Flier, W.M. (2007). Cognitive impairment in Alzheimer's disease is modified by APOE genotype. Dementia and Geriatric Cognitive Disorders, 24, 98–103.CrossRefGoogle ScholarPubMed
Vellas, B., Andrieu, S., Sampaio, C., Coley, N., Wilcock, G. (2008). Endpoints for trials in Alzheimer's disease: A European task force consensus. Lancet Neurology, 7, 436–450.CrossRefGoogle ScholarPubMed
Verhelst, N.D., Glas, C.A.W. (1995). The one parameter logistic model. In G.H. Fischer & I.W. Molenaar (Eds.), Rasch models, foundations, recent developments and applications (pp. 215–237) New York: Springer Verlag.Google Scholar
Walstra, G.J., Teunisse, S., Van Gool, W.A., Van Crevel, H. (1997). Reversible dementia in elderly patients referred to a memory clinic. Journal of Neurology, 244, 17–22.CrossRefGoogle ScholarPubMed
Wechsler, D. (1991). Wechsler intelligence scale for children — third edition (WISC - III). San Antonio: The Psychological Corporation.Google Scholar
Wechsler, D. (1997). Wechsler adult intelligence scale - III. San Antonio: The Psychological Corporation.Google Scholar
Wilcock, G.K., Lilienfeld, S., Gaens, E. (2000). Efficacy and safety of galantamine in patients with mild to moderate Alzheimer's disease: Multicentre randomized controlled trial. Galantamine International-1 Study Group. British Medical Journal, 321, 1–7.CrossRefGoogle ScholarPubMed
Wouters, H., Van Gool, W.A., Schmand, B., Lindeboom, R. (2008). Revising the ADAS-cog for a More Accurate Assessment of Cognitive Impairment. Alzheimer's Disease and Associated Disorders, 22, 236–244.CrossRefGoogle ScholarPubMed
Wouters, H., Van Gool, W.A., Schmand, B., Zwinderman, A.H., Lindeboom, R. (2009). Three sides of the same coin: Measuring global cognitive impairment with the MMSE, ADAS-cog and CAMCOG. International Journal of Geriatric Psychiatry, 25, 770–779.CrossRefGoogle Scholar