1
|
Jørgensen K, Nielsen TR, Nielsen A, Oxbøll AB, Gerner SD, Waldorff FB, Waldemar G. Diagnostic accuracy of the Brief Assessment of Impaired Cognition case-finding instrument in a general practice setting and comparison with other widely used brief cognitive tests-a cross-validation study. Eur J Neurol 2024:e16418. [PMID: 39045891 DOI: 10.1111/ene.16418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to examine the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) case-finding instrument in a general practice (GP) setting and compare it with other widely used brief cognitive instruments. METHODS Patients aged ≥70 years were prospectively recruited from 14 Danish GP clinics. Participants were classified as having either normal cognition (n = 154) or cognitive impairment (n = 101) based on neuropsychological test performance, reported instrumental activities of daily living, and concern regarding memory decline. Comparisons involved the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), the Mini-Cog, the 6-item Clock Drawing Test (CDT-6) and the BASIC Questionnaire (BASIC-Q). RESULTS BASIC demonstrated good overall classification accuracy with an area under the receiver operating characteristic curve (AUC) of 0.88 (95% confidence interval [CI] 0.84-0.92), a sensitivity of 0.72 (95% CI 0.62-0.80) and a specificity of 0.86 (95% CI 0.79-0.91). Pairwise comparisons of the AUCs of BASIC, MMSE, MoCA and RUDAS produced non-significant results, but BASIC had significantly higher classification accuracy than Mini-Cog, BASIC-Q and CDT-6. Depending on the pretest probability of cognitive impairment, the positive predictive validity of BASIC varied from 0.83 to 0.36, and the negative predictive validity from 0.97 to 0.76. CONCLUSIONS BASIC demonstrated good discriminative validity in a GP setting. The classification accuracy of BASIC is equivalent to more complex, time-consuming instruments, such as the MMSE, MoCA and RUDAS, and higher than very brief instruments, such as the CDT-6, Mini-Cog and BASIC-Q.
Collapse
Affiliation(s)
- Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ann Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Anne-Britt Oxbøll
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Sofie D Gerner
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans B Waldorff
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Oxbøll AB, Jørgensen K, Nielsen TR, Christiansen SD, Nielsen A, Waldorff FB, Waldemar G. Diagnostic accuracy of BASIC-Q for detection of cognitive impairment in a primary care setting - a cross-validation study. BMC Geriatr 2024; 24:53. [PMID: 38212693 PMCID: PMC10785536 DOI: 10.1186/s12877-024-04675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES This study aims to evaluate the diagnostic accuracy and reliability of a new, brief questionnaire, 'Brief Assessment of Impaired Cognition- Questionnaire' (BASIC-Q) for detection of cognitive impairment, primarily developed for use in primary care. BASIC-Q has three components: Self-report, Informant report, and Orientation. Self-report and Orientation are completed by the individual and Informant report is answered by a close relative. METHODS We included 275 participants ≥ 70 years, without a prior diagnosis of dementia, and with a close relative who agreed to participate as an informant. Participants were included prospectively in 14 general practices in urban and rural Denmark using a convenience sampling method. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the informant-completed Functional Activities Questionnaire (FAQ) and reported memory concern were used as a reference standard for the classification of the participants' cognitive function. RESULTS BASIC-Q demonstrated a fair to good diagnostic accuracy to differentiate between people with cognitive impairment and normal cognition with an area under the ROC curve (AUC) of 0.84 (95% CI 0.79-0.89) and a sensitivity and specificity of 0.80 (95% CI 0.72-0.87) and 0.71 (95% CI 0.63-0.78). A prorated BASIC-Q score derived from BASIC-Q without Informant report had significantly lower classification accuracy than the full BASIC-Q. The test-retest reliability of BASIC-Q was good with an intraclass correlation coefficient of 0.84. CONCLUSION BASIC-Q is a brief, easy-to-use questionnaire for identification of cognitive impairment in older adults. It demonstrated fair to good classification accuracy in a general practice setting and can be a useful case-finding tool when suspecting dementia in primary health care.
Collapse
Affiliation(s)
- Anne-Britt Oxbøll
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark.
| | - Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Sofie D Christiansen
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Frans B Waldorff
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Matias-Guiu JA, Delgado-Álvarez A. Novel cognitive screening tests to address new clinical priorities and cultural diversity. Eur J Neurol 2023; 30:799-801. [PMID: 36445003 DOI: 10.1111/ene.15653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Delgado-Álvarez
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
4
|
Jørgensen K, Nielsen TR, Nielsen A, Waldorff FB, Høgh P, Gottrup H, Vestergaard K, Oxbøll AB, Waldemar G. Validity of the Brief Assessment of Impaired Cognition case-finding instrument for identification of dementia subgroups and staging of dementia. Eur J Neurol 2023; 30:578-586. [PMID: 36380695 PMCID: PMC10107638 DOI: 10.1111/ene.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The aims of this study were to examine the psychometric properties of the Brief Assessment of Impaired Cognition (BASIC) case-finding instrument in clinical settings focusing on (i) test-retest reliability, (ii) the discriminative validity of BASIC and its components for identification of Alzheimer disease (AD) dementia and non-AD dementia, and (iii) the association of expert clinical rating of cognitive status with BASIC performance. METHODS The test-retest reliability analysis was based on a sample of general practice patients (n = 59) retested with a mean interval of 19 days. Discriminative validity analyses and analysis of the association of cognitive status with BASIC performance were based on data from the primary validation study of BASIC in memory clinics. RESULTS The test-retest reliability of BASIC was high (r = 0.861). No significant difference in discriminative validity was found for identification of AD dementia (sensitivity = 0.99, specificity = 0.98) and non-AD dementia (sensitivity = 0.90, specificity = 0.98). All components of BASIC contributed to the high discriminative validity of both AD and non-AD dementia. BASIC performance was significantly correlated with expert clinical rating of the cognitive status of patients. A crude staging model for cognitive status using BASIC score intervals had superior classification accuracy (70%) compared to a Mini-Mental State Examination (MMSE) score range-based model (58% accuracy). CONCLUSIONS BASIC is a reliable and valid case-finding instrument for AD dementia and non-AD dementia in clinical settings. BASIC performance is significantly associated with the degree of cognitive impairment, and BASIC seems to be superior to MMSE for staging of impairment.
Collapse
Affiliation(s)
- Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, University of Copenhagen-Rigshospitalet, Copenhagen, Denmark
| | - Thomas Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, University of Copenhagen-Rigshospitalet, Copenhagen, Denmark
| | - Ann Nielsen
- Danish Dementia Research Centre, Department of Neurology, University of Copenhagen-Rigshospitalet, Copenhagen, Denmark
| | - Frans Boch Waldorff
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Høgh
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Gottrup
- Dementia Clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Karsten Vestergaard
- Dementia Clinic, Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne-Britt Oxbøll
- Danish Dementia Research Centre, Department of Neurology, University of Copenhagen-Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, University of Copenhagen-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Yuan XF, Zhang Y, Zhang Y, Wu YH, Shi Y, Cheng Y, Xie F. Reliability and validity of the Brief Assessment of Impaired Cognition (Chinese version) for stroke patients. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:27-33. [PMID: 33879014 DOI: 10.1080/23279095.2021.1908287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following stroke. The aim of this study was to evaluate the validity and reliability of the Mandarin Chinese version of the Brief Assessment of Impaired Cognition (BASIC) in stroke patients. The English version of the BASIC scale was translated into Mandarin Chinese, and 56 stroke patients at a stroke treatment center were enrolled in the study. The Mini-Mental State Examination (MMSE) and BASIC scale were used to evaluate the patients' cognitive function, and content validity, structural validity, concurrent validity, internal consistency, interrater consistency and reliability and test-retest reliability were used to evaluate the test results. The correlation coefficients between each item of the BASIC scale and the total score were between 0.416 and 0.804 (p < 0.05). The total score on the BASIC scale was correlated with the total score on the MMSE (r = 0.479, p < 0.05). Four factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 74.932%. The factor loading of each item on the corresponding factor was > 0.5, indicating that the scale has good structural validity. Internal consistency was good (Cronbach's α = 0.821), as were interrater (ICC > 0.95) and test-retest reliability (ICC = 0.815-0.941). Therefore, the Chinese version of the BASIC scale has good reliability and validity and can assist in screening for cognitive dysfunction or dementia in stroke patients.
Collapse
Affiliation(s)
- Xiao-Fang Yuan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ye-Huan Wu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yue Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yun Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fan Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| |
Collapse
|
6
|
Delgado-Álvarez A, Nielsen TR, Delgado-Alonso C, Valles-Salgado M, López-Carbonero JI, García-Ramos R, Gil-Moreno MJ, Díez-Cirarda M, Matías-Guiu J, Matias-Guiu JA. Validation of the European Cross-Cultural Neuropsychological Test Battery (CNTB) for the assessment of mild cognitive impairment due to Alzheimer's disease and Parkinson's disease. Front Aging Neurosci 2023; 15:1134111. [PMID: 37213535 PMCID: PMC10196233 DOI: 10.3389/fnagi.2023.1134111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/10/2023] [Indexed: 05/23/2023] Open
Abstract
Background The Cross-Cultural Neuropsychological Test Battery (CNTB) is a novel test battery specifically designed to reduce the impact of multiculturality in cognitive assessment. Objective We aimed to validate the CNTB in Spaniards in patients with Alzheimer's disease (AD), including patients at mild cognitive impairment (MCI) and mild dementia stages, and Parkinson's disease with MCI (PD-MCI). Methods Thirty patients with AD-MCI, 30 with AD-dementia (AD-D), and 30 with PD-MCI were recruited. Each clinical group was compared against a healthy control group (HC) with no differences in sex, age, or years of education. Intergroup comparisons, ROC analysis, and cut-off scores were calculated. Results AD-MCI scored lower than HC in those subtests associated with episodic memory and verbal fluency. AD-D also showed lower scores in executive functions and visuospatial tests. Effect sizes for all the subtests were large. PD-MCI showed lower performance than HC in memory and executive functions, particularly on error scores, with large effect sizes. Comparing AD-MCI and PD-MCI, AD-MCI had lower memory scores, while PD-MCI showed the worst performance in executive functions. CNTB showed appropriate convergent validity with standardized neuropsychological tests measuring the same cognitive domains. We obtained similar cut-off scores to previous studies performed in other populations. Conclusions The CNTB showed appropriate diagnostic properties in AD and PD, including those stages with mild cognitive impairment. This supports the utility of the CNTB for the early detection of cognitive impairment in AD and PD.
Collapse
Affiliation(s)
- Alfonso Delgado-Álvarez
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
- Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Thomas Rune Nielsen
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen-Rigshospitalet, Copenhagen, Denmark
| | - Cristina Delgado-Alonso
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - María Valles-Salgado
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Juan I. López-Carbonero
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Rocío García-Ramos
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - María José Gil-Moreno
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - María Díez-Cirarda
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
| | - Jordi A. Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
- *Correspondence: Jordi A. Matias-Guiu ;
| |
Collapse
|
7
|
Mild Cognitive Impairment Is Associated with Poorer Nutritional Status on Hospital Admission and after Discharge in Acutely Hospitalized Older Patients. Geriatrics (Basel) 2022; 7:geriatrics7050095. [PMID: 36136804 PMCID: PMC9498394 DOI: 10.3390/geriatrics7050095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
In acutely hospitalized older patients (≥65 years), the association between mild cognitive impairment (MCI) and malnutrition is poorly described. We hypothesized that (1) MCI is associated with nutritional status on admission and after discharge; (2) MCI is associated with a change in nutritional status; and (3) a potential association is partly explained by frailty, comorbidity, medication use, and age. We combined data from a randomized controlled trial (control group data) and a prospective cohort study (ClinicalTrials.gov: NCT01964482 and NCT03052192). Nutritional status was assessed on admission and follow-up using the Mini Nutritional Assessment—Short Form. MCI or intact cognition (noMCI) was classified by three cognitive performance tests at follow-up. Data on frailty, comorbidity, medication use, and age were drawn from patient journals. MCI (n = 42) compared to noMCI (n = 47) was associated with poorer nutritional status with an average difference of −1.29 points (CI: −2.30; −0.28) on admission and −1.64 points (CI: −2.57; −0.70) at 4-week follow-up. Only age influenced the estimates of −0.85 (CI: −1.86; 0.17) and −1.29 (CI: −2.25; −0.34), respectively. In acutely hospitalized older patients, there is an association between MCI and poorer nutritional status upon admission and four weeks after discharge. The association is partly explained by higher age.
Collapse
|
8
|
Li S, Cui G, Jørgensen K, Cheng Z, Li Z, Xu H. Psychometric Properties and Measurement Invariance of the Chinese Version of the Brief Assessment of Impaired Cognition Questionnaire in Community-Dwelling Older Adults. Front Public Health 2022; 10:908827. [PMID: 35784243 PMCID: PMC9247353 DOI: 10.3389/fpubh.2022.908827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
This study aimed to verify the Chinese version of the Brief Assessment of Impaired Cognition Questionnaire (C-BASIC-Q), and provide a new tool for the future large-scale epidemiological investigation of cognitive function in China. From March to May 2021, a cross-sectional study of 2,144 Chinese community-dwelling older adults (men = 1,075, mean age = 72.01 years, SD = 6.96 years, ranging from 60–99 years) was conducted in Jinan. Exploratory and confirmatory factor analyses were performed to evaluate the factor structure of the C-BASIC-Q. Convergent validity was evaluated by correlations with the Mini-Mental State Examination (MMSE). Internal consistency and test-retest reliability were evaluated using Cronbach's alpha and retest correlations in a sub-sample (n = 129). Linear regression was used to analyze the impact of demographic factors on the MMSE and C-BASIC-Q scores. Measurement invariance was evaluated using a multi-group confirmatory factor analysis. The mean C-BASIC-Q score was 15.94 (SD = 3.43). Factor analysis suggested a three-factor structure of C-BASIC-Q (self-report, orientation, and informant report). The C-BASIC-Q score was significantly positively associated with the MMSE score, showing good convergent validity. Cronbach's alpha of the C-BASIC-Q was 0.862, and the test-retest correlation coefficient was significant (r = 0.952, p < 0.001), indicating good internal consistency and test-retest reliability. Measurement invariance analysis showed that C-BASIC-Q had configural, metric, and scalar invariance across sex, age, residence, education level and marital status. C-BASIC-Q was less affected by age, residence, education, and marital status than the MMSE. In summary, the C-BASIC-Q had good reliability, validity, and measurement invariance, and is a valid tool for evaluating cognitive functioning in Chinese community-dwelling older adults.
Collapse
Affiliation(s)
- Shaojie Li
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Guanghui Cui
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital, Beijing, China
| | - Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, University of Copenhagen, Copenhagen, Denmark
| | - Zimi Cheng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zihao Li
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Huilan Xu
- Xiangya School of Public Health, Central South University, Changsha, China
- *Correspondence: Huilan Xu
| |
Collapse
|
9
|
Nielsen TR. Cognitive Assessment in Culturally, Linguistically, and Educationally Diverse Older Populations in Europe. Am J Alzheimers Dis Other Demen 2022; 37:15333175221117006. [PMID: 36325840 PMCID: PMC10581111 DOI: 10.1177/15333175221117006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Due to increasing cultural, linguistic, and educational diversity in older populations across Europe, accurate assessment of cognitive functioning in people from diverse backgrounds becomes increasingly important. This paper aims to provide a state-of-the-art review of cognitive assessment in culturally, linguistically, and educationally diverse older populations in Europe, focusing on challenges and recent advances in cross-cultural assessment. Significant work has been carried out on the identification of challenges in cognitive assessment in culturally, linguistically, and educationally diverse older populations and on development and validation of cross-cultural cognitive tests. Most research has addressed the influences of language barriers, education and literacy, and culture and acculturation and in particular, the European Cross-Cultural Neuropsychological Test Battery (CNTB) and the Rowland Universal Dementia Assessment Scale (RUDAS) are well-validated across European countries. However, cross-cultural cognitive assessment is largely still a developing field in Europe, and there is a continuing need for developments within the field.
Collapse
Affiliation(s)
- T. Rune Nielsen
- Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
10
|
Jørgensen K, Nielsen TR, Nielsen A, Waldorff FB, Waldemar G. Validation of the Brief Assessment of Impaired Cognition and the Brief Assessment of Impaired Cognition Questionnaire for identification of mild cognitive impairment in a memory clinic setting. Int J Geriatr Psychiatry 2020; 35:907-915. [PMID: 32291812 PMCID: PMC7496829 DOI: 10.1002/gps.5312] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/03/2020] [Accepted: 04/11/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to validate the Brief Assessment of Impaired Cognition (BASIC) and the Brief Assessment of Impaired Cognition Questionnaire (BASIC-Q) for identification of mild cognitive impairment (MCI) in a memory clinic setting. METHODS A total of 163 sociodemographically matched patients (MCI, n = 42, and dementia, n = 121) and 83 control participants were included in the study. Two instruments were validated: (a) BASIC, including the components self-report, informant report, and two brief cognitive tests, and (b) BASIC-Q, including the components self-report, informant report, and orientation. BASIC can be administered in 5 minutes and BASIC-Q in less than 5 minutes. RESULTS A high discriminative validity for MCI vs control participants was found for both BASIC (sensitivity 0.86, specificity 0.89) and BASIC-Q (sensitivity 0.88, specificity 0.88). In comparison, the MMSE had low sensitivity (0.61) and moderate specificity (0.72). All components of BASIC and BASIC-Q contributed significantly to differentiate MCI from control participants. The components of BASIC and BASIC-Q also contributed significantly to differentiate MCI from dementia, except for self-report, which was identical in the two groups. CONCLUSIONS Both BASIC and BASIC-Q are brief, valid, and effective instruments for identification of patients with possible MCI in a memory clinic setting. Further cross-validation of the instruments in a general practice or primary care setting is needed.
Collapse
Affiliation(s)
- Kasper Jørgensen
- Department of Neurology, Danish Dementia Research CentreUniversity of CopenhagenCopenhagenDenmark
| | - Thomas R. Nielsen
- Department of Neurology, Danish Dementia Research CentreUniversity of CopenhagenCopenhagenDenmark
| | - Ann Nielsen
- Department of Neurology, Danish Dementia Research CentreUniversity of CopenhagenCopenhagenDenmark
| | - Frans B. Waldorff
- Section of General Practice, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark,Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research CentreUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
11
|
Jørgensen K, Nielsen TR, Nielsen A, Waldorff FB, Waldemar G. Brief Assessment of Impaired Cognition Questionnaire (BASIC-Q)-Development and validation of a new tool for identification of cognitive impairment in community settings. Int J Geriatr Psychiatry 2020; 35:693-701. [PMID: 32100328 PMCID: PMC7383627 DOI: 10.1002/gps.5286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/02/2020] [Accepted: 02/13/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Brief Assessment of Impaired Cognition (BASIC), which combines self- and informant report with cognitive testing, was previously found to be highly accurate in identification of dementia and cognitive impairment. The aim of the present study was to develop and validate a questionnaire version of BASIC, the BASIC-Q, for use in community settings. METHODS In order to construct a questionnaire version of BASIC, we substituted cognitive testing with questions regarding orientation. BASIC-Q was validated based on further analysis of data from the primary BASIC validation study, where patients consecutively referred from general practice were tested at their first memory clinic admission prior to diagnosis. Control participants were primarily recruited among participating patients' relatives. Expert clinical diagnosis was subsequently used as reference standard for estimation of classification accuracy. RESULTS A high discriminative validity (sensitivity 0.92, specificity 0.97) for cognitive impairment (n = 159) vs socio-demographically matched control participants (n = 109) was found. In comparison, the MMSE had 0.76 sensitivity and 0.81 specificity. Administration time for BASIC-Q was less than 5 minutes compared to approximately 10 minutes for the MMSE. CONCLUSIONS BASIC-Q is a brief, efficient and valid tool for identification of cognitive impairment in a clinical setting. Further validation in a community setting is needed.
Collapse
Affiliation(s)
- Kasper Jørgensen
- Danish Dementia Research Centre, Department of NeurologyUniversity of Copenhagen, RigshospitaletCopenhagenDenmark
| | - T. Rune Nielsen
- Danish Dementia Research Centre, Department of NeurologyUniversity of Copenhagen, RigshospitaletCopenhagenDenmark
| | - Ann Nielsen
- Danish Dementia Research Centre, Department of NeurologyUniversity of Copenhagen, RigshospitaletCopenhagenDenmark
| | - Frans Boch Waldorff
- Section of General Practice, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of NeurologyUniversity of Copenhagen, RigshospitaletCopenhagenDenmark
| |
Collapse
|
12
|
Jørgensen K, Nielsen TR, Nielsen A, Waldorff FB, Høgh P, Jakobsen S, Gottrup H, Vestergaard K, Waldemar G. Brief Assessment of Impaired Cognition (BASIC)-Validation of a new dementia case-finding instrument integrating cognitive assessment with patient and informant report. Int J Geriatr Psychiatry 2019; 34:1724-1733. [PMID: 31389089 PMCID: PMC6852234 DOI: 10.1002/gps.5188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to develop and validate a new brief and accurate case-finding instrument for dementia and cognitive impairment. Previous research indicates that combining cognitive tests with informant and/or patient report may improve accuracy in dementia case-finding. The Brief Assessment of Impaired Cognition (BASIC) integrates these three sources of information. METHODS BASIC was prospectively validated in five memory clinics. Patients consecutively referred from general practice were tested at their initial visit prior to diagnosis. Control participants were primarily recruited among participating patients' relatives. Expert clinical diagnosis was subsequently used as gold standard for estimation of the classification accuracy of BASIC. RESULTS A very high discriminative validity (specificity 0.98, sensitivity 0.95) for dementia (n = 122) versus socio-demographically matched control participants (n = 109) was found. In comparison, the MMSE had 0.90 specificity and 0.82 sensitivity. Extending the discriminative validity analysis to cognitive impairment (both dementia and MCI, n = 162) only slightly reduced the discriminative validity of BASIC whereas the discriminative validity of the MMSE was substantially attenuated. Administration time for BASIC was approximately 5 minutes compared with 10 to 15 minutes for the MMSE. CONCLUSIONS BASIC was found to be an efficient and valid case-finding instrument for dementia and cognitive impairment in a memory clinic setting.
Collapse
Affiliation(s)
- Kasper Jørgensen
- Danish Dementia Research CentreDepartment of NeurologyUniversity of CopenhagenCopenhagenDenmark
| | - T. Rune Nielsen
- Danish Dementia Research CentreDepartment of NeurologyUniversity of CopenhagenCopenhagenDenmark
| | - Ann Nielsen
- Danish Dementia Research CentreDepartment of NeurologyUniversity of CopenhagenCopenhagenDenmark
| | - Frans Boch Waldorff
- Section of General PracticeDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Peter Høgh
- Regional Dementia Research CentreZealand University HospitalRoskildeDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Søren Jakobsen
- Department of GeriatricsOdense University HospitalSvendborg HospitalSvendborgDenmark
| | - Hanne Gottrup
- Dementia ClinicDepartment of NeurologyAarhus University HospitalAarhusDenmark
| | - Karsten Vestergaard
- Dementia ClinicDepartment of NeurologyAalborg University HospitalAalborgDenmark
| | - Gunhild Waldemar
- Danish Dementia Research CentreDepartment of NeurologyUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|