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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]
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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

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