This study aims to develop a new evaluation method for quickly and conveniently screening cognitive impairment in the elderly. The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Subsequently, FCT efficiencies in differentiating normally cognitive ability from cognitive impairment were explored and compared with that of the Mini-Mental Status Evaluation (MMSE). Equipercentile equating method was utilized to create a crosswalk between scores of the FCT and MMSE. Further, the association of scores of the FCT and MMSE with hippocampal volumes was investigated. There were 241 subjects aged 60 years or above enrolled in this study, including 107 adults with cognitive abilities in normal range, 107 patients with mild cognitive impairment (MCI), and 27 patients with mild Alzheimer disease (AD). The AUC of FCT for detection of cognitive impairment (MCI and mild AD) was 0.885 (95% CI 0.838 to 0.922). The sensitivity and specificity of FCT for the diagnosis of cognitive impairment were 80.6% and 84.11 %, respectively. FCT’s diagnostic performance was superior to that of MMSE in the same cohort. Mean completion time of FCT was 339.9 ± 67.7 seconds (5-6 min). In addition, a conversion table between scores on the FCT and MMSE was created. Further, the FCT scores were positively correlated with hippocampal volumes. The FCT is a novel, reliable, and valid cognitive screening test for the detection of dementia at early stages.
Studies have shown that item difficulty can vary significantly based on the context of an item within a test form. In particular, item position may be associated with practice and fatigue effects that influence item parameter estimation. The purpose of this research was to examine the relevance of item position specifically for assessments used in early education, an area of testing that has received relatively limited psychometric attention. In an initial study, multilevel item response models fit to data from an early literacy measure revealed statistically significant increases in difficulty for items appearing later in a 20-item form. The estimated linear change in logits for an increase of 1 in position was .024, resulting in a predicted change of .46 logits for a shift from the beginning to the end of the form. A subsequent simulation study examined impacts of item position effects on person ability estimation within computerized adaptive testing. Implications and recommendations for practice are discussed.
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