Reliability and Validity of the Executive Interview (EXIT) and Quick EXIT Among Community Dwelling Older Adults

Abstract

Objectives To investigate the psychometric properties of the Executive Interview (EXIT) and Quick EXIT in community dwelling older adults. Design Secondary analysis of data obtained as part of a longitudinal study of cognitive function in late life depression. Setting: A university hospital. Participants Community dwelling adults (n=422), aged 59 years and older, with current or recent history of non-psychotic unipolar major depression, and never-depressed comparison subjects. Measurements The EXIT and other measures of executive control functions (ECF), non-executive cognitive domains and global cognitive function. We calculated Quick EXIT scores from the EXIT. Results The EXIT demonstrated high inter-rater reliability (Intraclass correlation coefficient = .978, F(7, 21) = 174.85, p < .001), while both the EXIT and Quick EXIT demonstrated moderate internal consistency (α= 0.66 and α = 0.68, respectively). Both tests also demonstrated acceptable convergent validity against several standard tests of ECF (rs −.399 to .322, except for the Trail Making Test B, where rs was .057 to .063) as well as against measures of multifactorial cognitive function (rs −.432 to .491). However, both tests demonstrated inconsistent discriminant validity against a variety of standard non-ECF tests (rs −.013 to .376). Conclusions Both the EXIT and the Quick EXIT have adequate reliability and appear to require ECF in this population. However, both the EXIT and the Quick EXIT also reflect non-ECF domains. The EXIT and Quick EXIT should be considered to be measures of global cognitive function rather than pure ECF measures. Given similar reliability and validity, the Quick EXIT should be preferred clinically as it is briefer and less burdensome than the full EXIT.

Assessment of executive functions in children and adolescents with acquired brain injury (ABI) using a novel complex multi-tasking computerised task: The Jansari assessment of Executive Functions for Children (JEF-C©)

“…Our results are in line with a previous study on the BADS-C, where internal consistency of the BADS-C was acceptable for the ABI group (alpha = .76) but low in controls (alpha = .41) (Longaud-Valès et al, 2016). Hence our results are not unexpected, and may accurately reflect the multidimensional nature of EF (Campbell et al, 2014). In addition, it should be noted that Cronbach's alpha may underestimate the internal consistency of ordinal scales with fewer than 5 levels of response, as is the case for the JEF-C © (Zumbo, Gadermann, & Zeisser, 2007).…”

Diagnosis and treatment of depression and cognitive impairment in late life

“…Screening tests and questionnaires can be useful for detecting select aspects of cognitive impairment. While the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (Table ) are relatively ubiquitous screening measures for gross cognitive impairment, other instruments, including the Mattis Dementia Rating Scale (MDRS‐2; Table ) and Executive Interview (EXIT), may be more sensitive to generalized cognitive decline . The Cornell Scale for Depression in Dementia may also aid in quantifying depressive symptoms and signs; this scale integrates informant with patient reports .…”

“…While the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment ( 34 and Executive Interview (EXIT), 35 may be more sensitive to generalized cognitive decline. 36 The Cornell Scale for Depression in Dementia may also aid in quantifying depressive symptoms and signs; this scale integrates informant with patient reports. 37 Among patients with suspected executive dysfunction who perform well on traditional measures of executive functioning, the Frontal Systems Behavior Scale (FrSBe) 38 can help characterize behavioral manifestations of executive deficits.…”

Depression and Cognition in the Elderly

“…Even with a normal MOCA score, however, subtle impairment in executive functioning (particularly in individuals with high cognitive reserve) may go undetected. Other screens that may probe more deeply into executive functioning include the QUICK EXIT (Campbell et al 2013) and the Frontal Assessment Battery (Dubois & Litvan 2000).…”