Psychometrics and diagnostics of Italian cognitive screening tests: a systematic review

Aiello, Edoardo Nicolò; Rimoldi, Sara Giordana; Bolognini, Nadia; Appollonio, Ildebrando; Arcara, Giorgio

doi:10.1007/s10072-021-05683-4

Cited by 25 publications

(17 citation statements)

References 73 publications

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“…Such an issue has to be particularly underlined as to those ROC analyses performed on clinical subsamples (Table 6), which should be treated as purely descriptive and preliminary. Second, further in-depth investigations are needed to assess the diagnostic properties, sensitivity to disease severity, responsiveness and reliable change of the t-FAB in neurological and geriatric cohorts [13]. Finally, with respect to the present stroke cohort, the discrepancies found in diagnostic accuracy between the t-FAB-M and t-FAB-V based on lesion side cannot be properly explored due to the small sample size of individuals presenting with either right-or left-lateralized damaged (N = 5 each).…”

Section: Discussionmentioning

confidence: 99%

“…Although several TBCS tools for the assessment of global cognitive status have been developed in recent years [6], no standardized test selectively screening executive functions is available, especially in Italy [13,14]. Indeed, fully standardized Italian TBCS tests are currently limited to multi-domain screening tests for global cognition [2,15].…”

Section: Introductionmentioning

confidence: 99%

“…a backward digit span (BDS) task[32] (HP subsample of N = 270: 110 males, 160 females; age: 47.24 ± 18.33 years, 18-96; education: 13.67 ± 3.63 years,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]…”

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confidence: 99%

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Telephone-based Frontal Assessment Battery (t-FAB): standardization for the Italian population and clinical usability in neurological diseases

et al. 2022

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Background Despite the relevance of telephone-based cognitive screening tests in clinical practice and research, no specific test assessing executive functioning is available. The present study aimed at standardizing and providing evidence of clinical usability for the Italian telephone-based Frontal Assessment Battery (t-FAB). Methods The t-FAB (ranging 0–12), comprising two subtests, has two versions: one requiring motor responses (t-FAB-M) and the other verbal responses (t-FAB-V). Three hundred and forty-six Italian healthy adults (HPs; 143 males; age range = 18–96 years; education range = 4–23 years) and 40 participants with neurological diseases were recruited. To HPs, the t-FAB was administered along with a set of telephone-based tests: MMSE, verbal fluency (VF), backward digit span (BDS). The in-person version of the FAB was administered to both HPs and clinical groups. Factorial structure, construct validity, inter-rater and test–retest reliability, t-FAB-M vs. t-FAB-V equivalence and diagnostic accuracy were assessed. Norms were derived via Equivalent Scores. Results In HPs, t-FAB measures yielded high inter-rater/test–retest reliability (ICC = .78–.94), were internally related (p ≤ .005) and underpinned by a single component, converging with the telephone-based MMSE, VF, BDS (p ≤ .0013). The two t-FAB versions were statistically equivalent in clinical groups (ps of both equivalence bounds < .001). Education predicted all t-FAB scores (p < .001), whereas age only the t-FAB-M score (p ≤ .004). t-FAB scores converge with the in-person FAB in HPs and clinical groups (rs = .43–.78). Both t-FAB versions were accurate in discriminating HPs from the clinical cohort (AUC = .73-.76). Discussion The t-FAB is a normed, valid, reliable and clinically usable telephone-based cognitive screening test to adopt in both clinical and research practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Telephone-based Frontal Assessment Battery (t-FAB): standardization for the Italian population and clinical usability in neurological diseases

et al. 2022

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“…Further investigations on the Itel-MMSE are thereupon needed to determine whether such inferences actually apply to target clinical populations [ 22 ]. In this last respect, it might be of interest for future studies to explore the potential of the Itel-MMSE in detecting cognitive complaints in healthy adults and in elderly related to the COVID-19 pandemic and its social restrictions [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, it remains to be derived norms specific to the remote modality of delivery [ 27 ], to assess its construct and criterion validity, also exploring the association with other telephone-based measures of cognitive status, as well as with in-person cognitive screening tests [ 29 , 30 ], including the assessment of the equivalence between the Itel-MMSE and its in-person version by adopting ad-hoc statistical methods [ 31 ]. Such a standardization study should also include the following aspects: the exploration of both the inter-rater and the test–retest reliability of the Itel-MMSE, considering the potential subjectivity in scoring approaches with remote assessments [ 30 ]; the assessment of the diagnostic properties of the Itel-MMSE mostly relevant for screening tests (i.e., sensitivity, specificity, positive and negative predictive values and likelihood ratios) [ 22 , 32 ], as well as of its ability to discriminate cases from controls and its sensitivity to detect changes over time [ 22 , 32 ]. With respect to psyhometrics, diagnostics and norms for telephone-based cognitive screening tests, two recent works by Aiello et al [ 33 , 34 ] can be taken as righteous approaches of standardization.…”

Section: Discussionmentioning

confidence: 99%

Italian telephone-based Mini-Mental State Examination (Itel-MMSE): item-level psychometric properties

et al. 2022

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Background The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses. Methods Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically. Results With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability. Discussion The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02041-4.

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Global Examination of Mental State: An open tool for the brief evaluation of cognition

et al. 2022

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Background The aim of this paper is to present a freely accessible new instrument for the evaluation of cognition: the Global Examination of Mental State (GEMS). Methods It is made up of 11 items tapping into a range of skills, such as Orientation in time and space, Memory, Working memory, Visuo‐spatial, Visuo‐constructional and Planning abilities, Perceptual and visual Attention, Language (Naming, Comprehension, and Verbal fluency), and Pragmatics. Results The psychometric strengths of this screening are: (1) extensive and updated normative data on the adult Italian population (from 18 to 100 years old); (2) absence of ceiling effect in healthy individuals, which allows to better detect interindividual variability; (3) comparison of the global scores with normative data taking into account Cognitive Reserve rather than only education, thus increasing diagnostic accuracy; (4) thresholds for significant change over time and the possibility to use parallel versions (GEMS‐A/GEMS‐B) for test‐retest; (5) solid psychometric properties and data on discriminant validity; and (6) free access to all materials (record forms, instructions, and cut‐off scores) on the web under a Creative Common License. Conclusions With all these characteristics, GEMS could be a very useful paper‐and‐pencil instrument for cognitive screening.

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Psychometrics and diagnostics of Italian cognitive screening tests: a systematic review

Cited by 25 publications

References 73 publications

Telephone-based Frontal Assessment Battery (t-FAB): standardization for the Italian population and clinical usability in neurological diseases

Telephone-based Frontal Assessment Battery (t-FAB): standardization for the Italian population and clinical usability in neurological diseases

Italian telephone-based Mini-Mental State Examination (Itel-MMSE): item-level psychometric properties

Global Examination of Mental State: An open tool for the brief evaluation of cognition

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