Self-Administered Screening for Mild Cognitive Impairment: Initial Validation of a Computerized Test Battery

Abstract

The CANS-MCI, a computer administered, scored, and interpreted touch screen battery, was evaluated for its ability to screen for mild cognitive impairment. 310 community-dwelling elders enrolled in an NIA-funded study. One-month test-retest reliability correlations were all significant (p<.05-p<.001). Concurrent validity correlations were all significant (p<.001). A high level of diagnostic validity was attained relative to the WMS-R LMS-II test (p<.001). Confirmatory factor analysis supported a three-factor model indicating the tests measure the intended cognitive dimensions of Memory, Language/Spatial Fluency, and Executive Function/Mental Control. Goodness of fit indicators were strong (Bentler Comparative Fit Index = .99; Root Mean Square Error of Approximation=.055). Initial validation analyses indicate that the CANS-MCI shows promise of being a reliable, valid screening tool to determine whether more intensive testing for early cognitive impairment is warranted. KeywordsScreening; Mild Cognitive Impairment; Computer; Neuropsychology; Tests Since most new research and treatments for dementia focus upon slowing the progression of Alzheimer's Disease (AD), 1,2 it is critical to identify the need for intensive diagnostic evaluation so that early treatment can delay AD progression. 3,4 People with Mild Cognitive Impairment (MCI), characterized by marked memory impairment without disorientation, confusion, or abnormal general cognitive functioning, appear to develop AD at a rate of 10-5% a year. 5-7 Research concerning MCI, both as a distinct diagnostic entity and as a precursor to AD, 6-11 suggests that instruments focused upon MCI measurement would provide useful screening information for decisions concerning full diagnostic evaluations for AD. Brief or automated neuropsychological tests may be the preliminary step most suited to determine the need for evaluations, which require costly neuropsychological, biochemical, or neuroimaging techniques. 12 While memory deficits have been found to be the most reliable single predictor, 5,10,13-15 studies indicate that tests sampling different cognitive domains, when combined, significantly enhance the predictive validity of a test battery because of variations in the initial cognitive deficits associated with AD. 15-19 Current methods of detection are costly and often deferred until later in the disease process, when interventions to delay AD are likely to be less effective. Therefore, an effective screening device for MCI would be cost efficient and incorporate tests that assess multiple cognitive domains. In this article, we present a reliability and validity study of a touch screen test battery that accomplishes these goals and is administered, scored, and METHODS SubjectsA community sample of 310 elderly people was recruited through senior centers, American Legion halls, and retirement homes in four counties of Washington State. Exclusionary criteria were non-English language, significant hand tremor, inability to sustain a seated position for 45 minutes, ...

Validation of a Self-Administered Computerized System to Detect Cognitive Impairment in Older Adults

“…However, the omnibus effect size for the VDR variables was much larger than the DAT variables (.35 versus .06). The overall results are consistent with the findings of Tornatore et al (2005), and this study supports the use of self-administered computerized assessment procedures as a valid screen for cognitive impairment in older adults. In the Tornatore et al (2005) study the unimpaired and impaired groups were defined using a cutoff of 10th percentile in performance on the Logical Memory II subtest of the Wechsler Memory Scale-Revised.…”

“…The overall results are consistent with the findings of Tornatore et al (2005), and this study supports the use of self-administered computerized assessment procedures as a valid screen for cognitive impairment in older adults. In the Tornatore et al (2005) study the unimpaired and impaired groups were defined using a cutoff of 10th percentile in performance on the Logical Memory II subtest of the Wechsler Memory Scale-Revised. The current study included measures of both verbal and nonverbal memory as well as a measure of executive functions to differentiate between impaired and unimpaired participants.…”

“…The affect on the health care system may actually be very positive rather than negative (Weimer & Sager, 2009). The accuracy and cost-efficiency of screening approaches is being addressed and progress is being made (Dwolatzky et al, 2003; Tornatore et al, 2005; Wild et al, 2008). …”

“…These approaches require trained professionals and involve evaluation of patient performance in various tasks. Tornatore, Hill, Laboff, and McGann (2005) have suggested that screening might be accomplished more economically using self-administered computerized systems which employ a touch-screen monitor to reduce the complexity of patient interactions with the computer. These authors evaluated 310 participants in Washington State and classified participants as Normal or Mild Cognitive Impairment (MCI) on the basis of the Wechsler Memory Scale-Revised Logical Memory Subtest delayed recall score (cutoff was the 10th percentile).…”

The Audio Recorded Cognitive Screen (ARCS): a flexible hybrid cognitive test instrument

“…The ARCS is similar to some computerised test batteries (CTBs) in that it is ‘self-administered’ and requires little input from a clinician/supervisor 24. Unlike most CTBs,3 however, the ARCS tests delayed free recall, a highly salient memory measure,25 in addition to delayed recognition.…”