Usefulness of the Cognitive Composition Test as an Early Discriminator of Mild Cognitive Impairment

Tests of abnormal gaze behavior increase the accuracy of mild cognitive impairment assessments

Tests to detect mild cognitive impairment (MCI) should have high sensitivity and accuracy. Previously, we reported on a cognitive composition test (CCT) that we developed to detect MCI. In this study, we compared gaze behavior parameters, namely, gaze fixation duration and gaze-shift frequency, during the CCT in participants with MCI and healthy controls (HC) to determine whether these parameters would accurately detect MCI in older adults. Participants performed CCT-A, -B, and -C tasks with varying difficulty levels while wearing eye-tracking devices. Performance time, gaze fixation duration, and gaze-shift frequency were analyzed. Receiver operating characteristic curve analysis was performed to assess the identification accuracy. The MCI group was significantly slower in completing the CCT-C task and had a higher gaze-shift frequency into both the sample object space and workspace than the HC group. Gaze fixation duration in the sample object space increased in the MCI group as the CCT became difficult. Our findings indicated that combining the CCT with performance time and gaze pattern improved the accuracy of distinguishing between individuals with and without MCI and that patients with MCI have abnormal gaze behavior during cognitive tasks. Therefore, evaluation of gaze parameters may improve the accuracy of identifying patients with MCI.

Eye on the Prize: Patient Outcomes Research in Medical Education

The overarching goal of medical education is to train clinicians who achieve and maintain competence in patient care. Although the field of medical education research has acknowledged the importance of education on clinical practices and outcomes, most research endeavors continue to focus on learner-centered outcomes, such as knowledge and attitudes. The absence of clinical and patient-centered outcomes in pulmonary and critical care medicine medical education research has been attributed to barriers at multiple levels, including financial, methodological, and practical considerations. This Perspective explores clinical outcomes relevant to pulmonary and critical care medicine educational research and offers strategies and solutions that educators can use to accomplish what many consider the "prize" of medical education research: an understanding of how our educational initiatives impact the health of patients.

Mini-ACE: Validation Study Among Older People in Long-Term Care

Background

The Mini-Addenbrooke's Cognitive Examination (M-ACE) is a valid and reliable tool that accurately differentiates various types of cognitive impairment from Normal-cognition assessed in multiple settings. However, its validity among older individuals in long-term care (LTC) was not yet established. Therefore, we sought to assess the Portuguese M-ACE's validity, reliability, and accuracy in detecting cognitive impairment no-dementia (CIND) in LTC users.

Methods

A comprehensive assessment was performed on 196 LTC Portuguese users aged ≥ 60 years, among whom 71 had Normal-cognition, and 125 had CIND.

Results

The M-ACE was found to be reliable (McDonald's ω = .86, Cronbach's α = .85) and consistent over time (r = .72; ICC = .83) and between raters (k = .92). Strong correlations with related measures supported construct validity (both r = .67). The M-ACE accurately distinguished CIND from Normal-cognition with a cut-off of 17 points (AUC = 0.81, Sensitivity = 81.7%, Specificity = 74.4%).

Conclusion

Our findings suggest that the Portuguese M-ACE is a valid and reliable cognitive assessment tool for LTC users, allowing for accurate differentiation between CIND and Normal-cognition. Thus, the M-ACE's use could contribute to the early detection and intervention of cognitive disorders, especially among older adults in LTC.