Regression-Based Norms for the Symbol Digit Modalities Test in the Dutch Population: Improving Detection of Cognitive Impairment in Multiple Sclerosis

Burggraaff, Jessica; Knol, Dirk L.; Uitdehaag, Bernard M. J.

doi:10.1159/000464405

Cited by 25 publications

(18 citation statements)

References 26 publications

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“…However much of the data has been generated from small studies, commonly involving 200 individuals or less [11,26,[31][32][33][52][53][54][55][56], and this has prohibited the generation of demographic-specific norms. Furthermore, the studies that are available have generally focused on specific patient samples (e.g., multiple sclerosis [57][58][59]), or younger adults [26,52,56,60,61]. There has been a lack of large scale normative SDMT data for older individuals, and particularly that which has considered variation according to key demographic characteristics that are known to influence cognitive performance [33].…”

Section: Discussionmentioning

confidence: 99%

“…Age is thought to be an important factor influencing performance on the SDMT [58], but only once individuals reach a certain age in later adulthood. The prior community studies that have focused specifically on older individuals, including 1780 French aged 70 years and over [53]; 354 Spanish aged 50-90 [66]; and 151 Danish aged 64-83 [54], have reported significant negative associations between age and SDMT scores.…”

Section: Discussionmentioning

confidence: 99%

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Normative Data for the Symbol Digit Modalities Test in Older White Australians and Americans, African-Americans, and Hispanic/Latinos

Ryan

Woods

Britt

et al. 2020

ADR

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Background: Processing speed, which can be assessed using the Symbol Digit Modalities Test (SDMT), is central to many brain functions. Processing speed declines with advanced age but substantial impairments are indicative of brain injury or disease. Objective: The purpose of this study was to provide SDMT normative data for older community-dwelling individuals in the U.S. and Australia. Methods: The ASPREE trial recruited 19,114 relatively healthy older men and women in Australia and the U.S. from the general community. All participants were without a diagnosis of dementia and with a Modified Mini-Mental State examination score of 78 or more at enrolment. The SDMT was administered at baseline as part of a neuropsychological test battery. Results: The median age of participants was 74 years (range 65-99), and 56% were women. The median years of education was 12. Ethno-racial differences in SDMT performance were observed and normative data were thus presented separately for 16,289 white Australians, 1,082 white Americans, 891 African-Americans, and 316 Hispanic/Latinos. There were consistent positive associations found between SDMT and education level, and negative associations between SDMT and age. Mean scores for women were consistently higher than men with the exception of Hispanic/Latinos aged ≥70 years. Conclusion: This study provides comprehensive SDMT normative data for whites (Australian and U.S.), Hispanic/Latinos, and African-Americans, according to gender, age, and education level. These norms can be used clinically as reference standards to screen for cognitive impairments in older individuals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Normative Data for the Symbol Digit Modalities Test in Older White Australians and Americans, African-Americans, and Hispanic/Latinos

Ryan

Woods

Britt

et al. 2020

ADR

View full text Add to dashboard Cite

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“…The next step is to develop regression-based norms for the oral version SDMT that will simultaneously take into account age, gender, education, and IQ. Compared to conventional normative data, as described within, regression-based norms increase estimate stability, require smaller samples, and have been shown to more accurately detect cognitive impairment among individuals with MS, (Parmenter et al, 2010;Burggraaff et al, 2017) TBI, MCI, and dementia. (Fellows and Schmitter-Edgecombe, 2020) Many of the previous attempts at developing regression-based norms have been derived from much smaller samples (~100) and have not taken the strict approach found in normative samples as the one described within.…”

Section: Discussionmentioning

confidence: 99%

A new look at an old test: Normative data of the symbol digit modalities test –Oral version

Strober

Bruce

Arnett

et al. 2020

Multiple Sclerosis and Related Disorders

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Background: The Symbol Digit Modalities Tests (SDMT) is the most sensitive measure to multiple sclerosis (MS)related cognitive dysfunction. However, existing normative data has been under scrutiny. Specifically, they are outdated, do not take into account gender, and are poorly stratified by education. More importantly, there exists no oral only version norms, which is typical administration among individuals with MS. Objective: The present investigation aimed to develop updated normative data of the oral version SDMT in which age, gender, and education were taken into consideration. Methods: A total of 675 healthy individuals, stratified by age, gender, and education completed the oral version SDMT. Results: Significant effects were found for age, gender, and education, consistent with previous contentions. Specifically, performance on the SDMT tends to decline with age, with the most noticeable decline beginning in the third decade of life and continuing into the sixth decade. Women, in general perform better than men, with an average of 5.1 more points. Finally, education effects were apparent among those aged 25-54. Conclusion: Based on these findings, updated normative data are provided. Utilization of these updated norms will result in a much needed and more accurate assessment of processing speed for individuals with MS.

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“…As our sample size was not large enough to create these subgroups, a combined approach was chosen in the current study: a regression-based correction for age was applied, and additionally, if sex and/or education significantly predicted test performance, subgroups based on sex and/or educational level were created. Regression based norms were shown to be valid for both the MACFIMS (Parmenter et al, 2010) and the SDMT (Burggraaff et al, 2017). Using regression-based correction for age allowed us to keep our sample size as large as possible, with N = 39 in the smallest subgroup (CVLT-II; women with a low educational level).…”

Section: Discussionmentioning

confidence: 99%

Introducing Multiple Screener: An unsupervised digital screening tool for cognitive deficits in MS

Dongen

Westerik

Hiele

et al. 2020

Multiple Sclerosis and Related Disorders

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Background: Cognitive deficits affect up to 70% of all patients with Multiple Sclerosis (MS) and have a significant impact on quality of life. Cognitive assessments need to be performed by a neuropsychologist and are often timeconsuming, hampering timely identification and adequate monitoring of cognitive decline in MS. Objective: To develop a time-efficient, unsupervised, digital tool to screen for cognitive deficits in MS. Methods: A digital (adjusted) version of the Brief International Cognitive Assessment for MS, including the Symbol Digit Modalities Test (SDMT, information processing speed), the California Verbal Learning Test (CVLT-II, verbal memory) and the Spatial Recall Test (SPART, visuospatial memory) was developed: Multiple Screener (intellectual property of Sanofi Genzyme). Firstly, the clarity and feasibility of the tool was confirmed by 16 patients with MS (mean age 50.9 years (SD 9.4, range 37-68). Next, in 60 healthy controls (HCs, mean age 44.5 years (SD 14.0, range 18-67), intraclass correlation coefficients (ICC) were calculated to describe how strongly the digital version resembled the paper and pencil-based assessment. Finally, 236 HCs (mean age 42.8 years (SD 12.8, range 18-69) were included to obtain norm scores for each test. Results: ICCs between digital and paper and pencil-based assessment were excellent to good (SDMT (ICC 0.79, confidence interval (CI) 0.67-0.87); CVLT-II (ICC 0.77, CI 0.64-0.85); SPART (ICC 0.61, CI 0.42-0.75)). For each test, a regression-based correction for the effect of age was applied on the raw scores before converting them to norm Z-scores. Additionally, the SDMT scores needed correction for education and the CVLT-II for education and sex (subgroups were created). Conclusions: Performance on an adjusted, digital version of the BICAMS correlates highly with the standard paper-and-pencil based test scores in HCs. Multiple Screener is an unsupervised, digital tool, with available norm scores, ultimately allowing for easy monitoring of cognitive decline in patients with MS.

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Regression-Based Norms for the Symbol Digit Modalities Test in the Dutch Population: Improving Detection of Cognitive Impairment in Multiple Sclerosis

Cited by 25 publications

References 26 publications

Normative Data for the Symbol Digit Modalities Test in Older White Australians and Americans, African-Americans, and Hispanic/Latinos

Normative Data for the Symbol Digit Modalities Test in Older White Australians and Americans, African-Americans, and Hispanic/Latinos

A new look at an old test: Normative data of the symbol digit modalities test –Oral version

Introducing Multiple Screener: An unsupervised digital screening tool for cognitive deficits in MS

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