Age-correction of test scores reduces the validity of mild cognitive impairment in predicting progression to dementia

A phase of mild cognitive impairment (MCI) precedes most forms of neurodegenerative dementia. Many definitions of MCI recommend the use of test norms to diagnose cognitive impairment. It is, however, unclear whether the use of norms actually improves the detection of individuals at risk of dementia....

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Published in:PloS one 2014-08, Vol.9 (8), p.e106284-e106284
Main Authors: Hessler, Johannes, Tucha, Oliver, Förstl, Hans, Mösch, Edelgard, Bickel, Horst
Format: Article
Language:English
Subjects:
Activities of daily living
Age
Age Factors
Aged
Aged, 80 and over
Biology and Life Sciences
Cognition Disorders - complications
Cognition Disorders - physiopathology
Cognitive ability
Dementia
Dementia - complications
Dementia - physiopathology
Dementia disorders
Education
Female
Humans
Impairment
Male
Medicine and Health Sciences
Memory
Models, Biological
Neuropsychology
Norms
Psychiatry
Psychotherapy
Studies
Test procedures
Validity
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Tucha, Oliver
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description A phase of mild cognitive impairment (MCI) precedes most forms of neurodegenerative dementia. Many definitions of MCI recommend the use of test norms to diagnose cognitive impairment. It is, however, unclear whether the use of norms actually improves the detection of individuals at risk of dementia. Therefore, the effects of age- and education-norms on the validity of test scores in predicting progression to dementia were investigated. Baseline cognitive test scores (Syndrome Short Test) of dementia-free participants aged ≥65 were used to predict progression to dementia within three years. Participants were comprehensively examined one, two, and three years after baseline. Test scores were calculated with correction for (1) age and education, (2) education only, (3) age only and (4) without correction. Predictive validity was estimated with Cox proportional hazard regressions. Areas under the curve (AUCs) were calculated for the one-, two-, and three-year intervals. 82 (15.3%) of initially 537 participants, developed dementia. Model coefficients, hazard ratios, and AUCs of all scores were significant (p
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Many definitions of MCI recommend the use of test norms to diagnose cognitive impairment. It is, however, unclear whether the use of norms actually improves the detection of individuals at risk of dementia. Therefore, the effects of age- and education-norms on the validity of test scores in predicting progression to dementia were investigated. Baseline cognitive test scores (Syndrome Short Test) of dementia-free participants aged ≥65 were used to predict progression to dementia within three years. Participants were comprehensively examined one, two, and three years after baseline. Test scores were calculated with correction for (1) age and education, (2) education only, (3) age only and (4) without correction. Predictive validity was estimated with Cox proportional hazard regressions. Areas under the curve (AUCs) were calculated for the one-, two-, and three-year intervals. 82 (15.3%) of initially 537 participants, developed dementia. Model coefficients, hazard ratios, and AUCs of all scores were significant (p&lt;0.001). Predictive validity was the lowest with age-corrected scores (-2 log likelihood  = 840.90, model fit χ2 (1)  = 144.27, HR  = 1.33, AUCs between 0.73 and 0.87) and the highest with education-corrected scores (-2 log likelihood  = 815.80, model fit χ2 (1)  = 171.16, HR  = 1.34, AUCs between 0.85 and 0.88). The predictive validity of test scores is markedly reduced by age-correction. 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subjects Activities of daily living
Age
Age Factors
Aged
Aged, 80 and over
Biology and Life Sciences
Cognition Disorders - complications
Cognition Disorders - physiopathology
Cognitive ability
Dementia
Dementia - complications
Dementia - physiopathology
Dementia disorders
Education
Female
Humans
Impairment
Male
Medicine and Health Sciences
Memory
Models, Biological
Neuropsychology
Norms
Psychiatry
Psychotherapy
Studies
Test procedures
Validity
title Age-correction of test scores reduces the validity of mild cognitive impairment in predicting progression to dementia
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