Does Adaptive Cognitive Testing Combine Efficiency with Precision? Prospective Findings

Abstract

Longer cognitive tests, such as the Alzheimer's disease assessment scale (ADAS-cog) or the Cambridge cognitive examination (CAMCOG), are more precise but less efficient than briefer tests, such as the Mini Mental State Examination (MMSE). We examined if computerized adaptive testing (CAT) of cognitive impairment can combine brevity with precision by tailoring a precise test to each individual patient. We conducted a prospective study of 84 participants [normal aging, n = 41; mild cognitive impairment (MCI), n = 21; dementia, n = 22]. CAT estimated a participant's ability during testing by selecting only items of appropriate difficulty from either the CAMCOG or the CAMCOG supplemented with ADAS-cog items and neuropsychological tests (the CAMCOG-Plus). After tailored testing with CAT, the remaining CAMCOG and CAMCOG-Plus items not selected by CAT were administered. The time needed to complete the CAT was compared to that needed for the whole CAMCOG and CAMCOG-Plus. Results showed that testing time reductions achieved with CAT were 37% or more compared to the whole CAMCOG and 55% or more compared to the whole CAMCOG-Plus. Estimated ability levels with CAT were in excellent agreement with those based on the whole CAMCOG and CAMCOG-Plus (intraclass correlations 0.99 and 0.98, respectively). Diagnostic accuracy of detecting mild dementia and MCI seemed better for the CAT administered tests than for the MMSE, but the differences were not significant. We conclude that adaptive testing combines brevity with precision, especially in grading the severity of cognitive impairment.

Screening for Mild Cognitive Impairment and Dementia with Automated, Anonymous Online and Telephone Cognitive Self-Tests

“…A possibility in this regard would be to develop a computerized adaptive testing version of the online self-test [32]. This would enable tailored testing by selecting only items of appropriate difficulty depending on a patient’s global cognitive ability and would thereby shorten the administration time in a more flexible manner.…”

Applications of Technology in Neuropsychological Assessment

“…Computerized tests have the advantage of algorithmic design, which can be used to tailor testing for specific populations (e.g., Hanna-Pladdy et al, 2010; Wouters et al, 2011). Computerized tests have also been shown to provide increased ease and standardization of administration (Fillit, Simon, Doniger, & Cummings, 2008), reduction in errors during scoring and interpretation (Koski et al, 2011), and readily accessible assessment without significant time devoted to preparation of materials (Koski et al, 2011).…”

Individualized evaluation of cholinesterase inhibitors effects in dementia with adaptive cognitive testing

“…Consistent with previous findings (Wouters et al, 2009a(Wouters et al, , 2009b(Wouters et al, , 2011, the results of this study support the potential of adaptive cognitive testing to establish an optimal trade-off between precision and brevity. A substantial test reduction of about 60% was observed for the adaptive C-47 compared to the whole C-47 (47 CAMCOG item set).…”

“…A previously validated CAT algorithm (Wouters et al, 2009a(Wouters et al, , 2009b(Wouters et al, , 2011Lindeboom et al, 2004) was examined. Item difficulties of the CAT algorithm were fixed according to the item difficulties of a validated set of 47 CAMCOG items previously published (Lindeboom et al, 2004).…”

“…Adaptive testing has the potential to considerably shorten extensive cognitive tests and to make them much more patient-friendly and feasible for routine administration in outpatient settings. Our previous research (Wouters et al, 2009a(Wouters et al, , 2009b(Wouters et al, , 2011 showed that adaptive testing indeed combines precision with feasibility. Compared to the whole test, test reductions of up to 40% to 60% were found with only slight loss of precision.…”