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Kent K, Adly Ibrahim N, Romero K, Baker S, Greenacre M, Boucher CM, Roth RM, Erdodi LA. Compassion Versus Accuracy: Lenient Scoring of the Spatial Orientation Items on the Mini-mental State Exam Lowers Sensitivity. Alzheimer Dis Assoc Disord 2024; 38:98-100. [PMID: 38300875 DOI: 10.1097/wad.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024]
Abstract
The Mini-mental State Examination (MMSE) is a commonly used screening tool for cognitive impairment. Lenient scoring of spatial orientation errors (SOEs) on the MMSE is common and negatively affects its diagnostic utility. We examined the effect of lenient SOE scoring on MMSE classification accuracy in a consecutive case series of 103 older adults (age 60 or above) clinically referred for neuropsychological evaluation. Lenient scoring of SOEs on the MMSE occurred in 53 (51.4%) patients and lowered the sensitivity by 7% to 18%, with variable gains in specificity (0% to 11%) to psychometrically operationalized cognitive impairment. Results are consistent with previous reports that lenient scoring is widespread and attenuates the sensitivity of the MMSE. Given the higher clinical priority of correctly detecting early cognitive decline over specificity, a warning against lenient scoring of SOEs (on the MMSE and other screening tools) during medical education and in clinical practice is warranted.
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Affiliation(s)
- Katrina Kent
- Schulich Medical School at Western University, London
| | | | - Kristoffer Romero
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Shannon Baker
- Schulich Medical School at Western University, London
| | | | - Chantal M Boucher
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Robert M Roth
- Department of Psychiatry, Dartmouth Health, Lebanon, NH
| | - Laszlo A Erdodi
- Department of Psychology, University of Windsor, Windsor, ON, Canada
- Star UBB Institute, Babeș-Bolyai University, M. Kogalniceanu St 1, Cluj-Napoca, Romania
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Hlávka JP, Kinoshita AT, Fang S, Hunt A. Clinical Outcome Measure Crosswalks in Alzheimer's Disease: A Systematic Review. J Alzheimers Dis 2021; 83:591-608. [PMID: 34334392 PMCID: PMC10382157 DOI: 10.3233/jad-210060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A key challenge in studies that model outcomes, disease progression, and cost-effectiveness of existing and emerging dementia treatments is the lack of conversion criteria to translate, or 'crosswalk', scores on multiple measurement scales. Clinical status in dementia is commonly characterized in the cognitive, functional, and behavioral domains. OBJECTIVE We conducted a systematic review of peer-reviewed dementia measure crosswalks in the three domains. METHODS We systematically reviewed published literature for crosswalks between scales used to measure cognitive, functional, or behavioral outcomes in Alzheimer's and related dementias. The search was conducted in PubMed, and additional crosswalks were identified through snowballing and expert input from dementia modelers. RESULTS Of the reviewed articles, 2,334 were identified through a PubMed search, 842 articles were sourced from backward and forward citation snowballing, and 8 additional articles were recommended through expert input. 31 papers were eligible for inclusion, listing 74 unique crosswalks. Of those, 62 (83.8%) were between endpoints of the cognitive domain and 12 (16.2%) were either between endpoints of the functional domain or were hybrid in nature. Among crosswalks exclusively in the cognitive domain, a majority involved the Mini-Mental State Examination (MMSE) (37 crosswalks) or the Montreal Cognitive Assessment (MoCA) and its variants (25 crosswalks). MMSE was directly compared to MoCA or MoCA variants in 16 crosswalks. CONCLUSION Existing crosswalks between measures of dementia focus largely on a limited selection of outcome measures, particularly MMSE and MoCA. Few crosswalks exist in the functional domain, and no crosswalks were identified for solely behavioral measures.
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Affiliation(s)
- Jakub P Hlávka
- Sol Price School of Public Policy, Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Andrew T Kinoshita
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samantha Fang
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Adriana Hunt
- College of Science, University of Notre Dame, Notre Dame, IN, USA
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Abeare K, Romero K, Cutler L, Sirianni CD, Erdodi LA. Flipping the Script: Measuring Both Performance Validity and Cognitive Ability with the Forced Choice Recognition Trial of the RCFT. Percept Mot Skills 2021; 128:1373-1408. [PMID: 34024205 PMCID: PMC8267081 DOI: 10.1177/00315125211019704] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In this study we attempted to replicate the classification accuracy of the newly introduced Forced Choice Recognition trial (FCR) of the Rey Complex Figure Test (RCFT) in a clinical sample. We administered the RCFTFCR and the earlier Yes/No Recognition trial from the RCFT to 52 clinically referred patients as part of a comprehensive neuropsychological test battery and incentivized a separate control group of 83 university students to perform well on these measures. We then computed the classification accuracies of both measures against criterion performance validity tests (PVTs) and compared results between the two samples. At previously published validity cutoffs (≤16 & ≤17), the RCFTFCR remained specific (.84-1.00) to psychometrically defined non-credible responding. Simultaneously, the RCFTFCR was more sensitive to examinees' natural variability in visual-perceptual and verbal memory skills than the Yes/No Recognition trial. Even after being reduced to a seven-point scale (18-24) by the validity cutoffs, both RCFT recognition scores continued to provide clinically useful information on visual memory. This is the first study to validate the RCFTFCR as a PVT in a clinical sample. Our data also support its use for measuring cognitive ability. Replication studies with more diverse samples and different criterion measures are still needed before large-scale clinical application of this scale.
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Affiliation(s)
- Kaitlyn Abeare
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Kristoffer Romero
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Laura Cutler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | | | - Laszlo A Erdodi
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
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Tang X, Liu S, Cai J, Chen Q, Xu X, Mo CB, Xu M, Mai T, Li S, He H, Qin J, Zhang Z. Effects of Gene and Plasma Tau on Cognitive Impairment in Rural Chinese Population. Curr Alzheimer Res 2021; 18:56-66. [PMID: 33761861 DOI: 10.2174/1567205018666210324122840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 01/13/2021] [Accepted: 03/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sufficient attention was not paid to the effects of microtubule-associated protein tau (MAPT) and plasma tau protein on cognition. OBJECTIVE A total of 3072 people in rural China were recruited. They were provided with questionnaires, and blood samples were obtained. METHODS The MMSE score was used to divide the population into cognitive impairment group and control group. First, logistic regression analysis was used to explore the possible factors influencing cognitive function. Second, 1837 samples were selected for SNP detection through stratified sampling. Third, 288 samples were selected to test three plasma biomarkers (tau, phosphorylated tau, and Aβ-42). RESULTS For the MAPT rs242557, people with AG genotypes were 1.32 times more likely to develop cognitive impairment than those with AA genotypes, and people with GG genotypes were 1.47 times more likely to develop cognitive impairment than those with AG phenotypes. The plasma tau protein concentration was also increased in the population carrying G (P = 0.020). The plasma tau protein was negatively correlated with the MMSE score (P = 0.004). CONCLUSION The mutation of MAPT rs242557 (A > G) increased the risk of cognitive impairment and the concentration of plasma tau protein.
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Affiliation(s)
- Xu Tang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
| | - Shuzhen Liu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
| | - Jiansheng Cai
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
| | - Quanhui Chen
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
| | - Xia Xu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
| | - Chun B Mo
- Guilin Medical University, No. 109, North Second Huancheng Road, Guilin 541004,China
| | - Min Xu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
| | - Tingyu Mai
- Guilin Medical University, No. 109, North Second Huancheng Road, Guilin 541004,China
| | - Shengle Li
- Guilin Medical University, No. 109, North Second Huancheng Road, Guilin 541004,China
| | - Haoyu He
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
| | - Jian Qin
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
| | - Zhiyong Zhang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021,China
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Erdodi LA, Shahein AG, Kent KJ, Roth RM. The doubtful benefits of giving the benefit of the doubt: Lenient scoring of the spatial orientation items on the mini-Mental Status Exam increases false negative rates. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:143-149. [PMID: 30265564 DOI: 10.1080/23279095.2018.1497990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Lenient scoring of spatial orientation errors (SOE) on the Mini-Mental State Exam (MMSE) is common practice, even though it deviates from standard protocol and may compromise its diagnostic power. This study was designed to empirically evaluate the effect of lenient scoring on the MMSE's classification accuracy. Participants were 113 community dwelling older adults recruited for a research study, representing a wide range of range of neurological status from cognitively healthy to Alzheimer's disease. Clinical classification was determined by expert assessors based on multiple sources of clinical evidence. Lenient scoring significantly inflated MMSE total scores (d = .88, large effect), and suppressed failure rates (from 26% to 14%). Standard scoring produced superior overall classification accuracy (75% vs. 67%) over lenient scoring and, more importantly, increased sensitivity from .33 to .53, with minimal loss in specificity (from 1.00 to .95). SOEs are empirical markers of cognitive decline and should not be adjusted based on clinical judgment. Results indicate that diminished sensitivity to cognitive impairment is an unintended consequence of lenient scoring and argue against this practice.
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Affiliation(s)
- Laszlo A Erdodi
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, Ontario, Canada
| | - Ayman G Shahein
- The Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Katrina J Kent
- The Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Robert M Roth
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Blood-Brain Glucose Transfer in Alzheimer's disease: Effect of GLP-1 Analog Treatment. Sci Rep 2017; 7:17490. [PMID: 29235507 PMCID: PMC5727512 DOI: 10.1038/s41598-017-17718-y] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022] Open
Abstract
There are fewer than normal glucose transporters at the blood-brain barrier (BBB) in Alzheimer’s disease (AD). When reduced expression of transporters aggravates the symptoms of AD, the transporters become a potential target of therapy. The incretin hormone GLP-1 prevents the decline of cerebral metabolic rate for glucose (CMRglc) in AD, and GLP-1 may serve to raise transporter numbers. We hypothesized that the GLP-1 analog liraglutide would prevent the decline of CMRglc in AD by raising blood-brain glucose transfer, depending on the duration of disease. We randomized 38 patients with AD to treatment with liraglutide (n = 18) or placebo (n = 20) for 6 months, and determined the blood-brain glucose transfer capacity (Tmax) in the two groups and a healthy age matched control group (n = 6). In both AD groups at baseline, Tmax estimates correlated inversely with the duration of AD, as did the estimates of CMRglc that in turn were positively correlated with cognition. The GLP-1 analog treatment, compared to placebo, highly significantly raised the Tmax estimates of cerebral cortex from 0.72 to 1.1 umol/g/min, equal to Tmax estimates in healthy volunteers. The result is consistent with the claim that GLP-1 analog treatment restores glucose transport at the BBB.
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Nielsen RB, Egefjord L, Angleys H, Mouridsen K, Gejl M, Møller A, Brock B, Brændgaard H, Gottrup H, Rungby J, Eskildsen SF, Østergaard L. Capillary dysfunction is associated with symptom severity and neurodegeneration in Alzheimer's disease. Alzheimers Dement 2017; 13:1143-1153. [PMID: 28343848 DOI: 10.1016/j.jalz.2017.02.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/13/2017] [Accepted: 02/13/2017] [Indexed: 01/18/2023]
Abstract
INTRODUCTION We examined whether cortical microvascular blood volume and hemodynamics in Alzheimer's disease (AD) are consistent with tissue hypoxia and whether they correlate with cognitive performance and the degree of cortical thinning. METHODS Thirty-two AD patients underwent cognitive testing, structural magnetic resonance imaging (MRI), and perfusion MRI at baseline and after 6 months. We measured cortical thickness, microvascular cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and capillary transit time heterogeneity (CTH) and estimated tissue oxygen tension (PtO2). RESULTS At baseline, poor cognitive performance and regional cortical thinning correlated with lower CBF and CBV, with higher MTT and CTH and with low PtO2 across the cortex. Cognitive decline over time was associated with increasing whole brain relative transit time heterogeneity (RTH = CTH/MTT). DISCUSSION Our results confirm the importance of microvascular pathology in AD. Deteriorating microvascular hemodynamics may cause hypoxia, which is known to precipitate amyloid retention.
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Affiliation(s)
- Rune B Nielsen
- Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark.
| | - Lærke Egefjord
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Hugo Angleys
- Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark
| | - Kim Mouridsen
- Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark
| | - Michael Gejl
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Arne Møller
- PET-Center, Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Brock
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Brændgaard
- Dementia Clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Gottrup
- Dementia Clinic, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Rungby
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Simon F Eskildsen
- Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark; Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
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Kaya D, Isik AT, Usarel C, Soysal P, Ellidokuz H, Grossberg GT. The Saint Louis University Mental Status Examination Is Better than the Mini-Mental State Examination to Determine the Cognitive Impairment in Turkish Elderly People. J Am Med Dir Assoc 2016; 17:370.e11-5. [DOI: 10.1016/j.jamda.2015.12.093] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
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