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Alternate forms of logical memory and verbal fluency tasks for repeated testing in early cognitive changes
- Alwin Cunje, D. William Molloy, Timothy I. Standish, David L. Lewis
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- Journal:
- International Psychogeriatrics / Volume 19 / Issue 1 / February 2007
- Published online by Cambridge University Press:
- 10 May 2006, pp. 65-75
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- Article
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Background: Repeat cognitive testing is an essential diagnostic strategy to measure changes in cognition over time when following people with memory problems. Alternate forms may avert practice effects that can mimic improvements in cognition. We evaluated alternate forms of verbal fluency and logical memory (paragraph recall) tasks to evaluate their equivalence for clinical use.
Methods: Participants with mild cognitive impairment (MCI) and dementia were recruited from five outpatient memory clinics and one nursing home. Participants with normal cognition (NC) were recruited from family members or friends. Verbal fluency categories of animals, cities & towns, fruits & vegetables and first names were used. Scores were recorded for 0–30 seconds, 31–60 seconds and errors. For the logical memory task, participants were read one of three different paragraphs and then were asked to recall the story. Immediate recall and delayed recall scores were recorded. The Standardized Mini-mental State Examination, the AB Cognitive Screen and the 15-point Geriatric Depression Scale were administered as part of the assessment. Analyses were performed using means, frequency distributions, t-tests, receiver-operating characteristic curves and effect sizes.
Results: There were 46 NC participants, 45 with MCI and 55 with dementia. For verbal fluency, the mean number of animals, cities & towns, names or fruits & vegetables named in 60 seconds did not differ significantly within each cognitive group. First names was an easier category than the others: NC named 16.9–22.3 items, MCI named 11.6–14.4 items and dementia named 8.1–11.4 items. The mean number of items immediately recalled in logical memory was not significantly different for the three paragraphs. The verbal fluency task (in 60 seconds) and logical memory immediate recall were highly sensitive and specific to differences between NC and MCI (areas under the curves 0.87 and 0.76, respectively).
Conclusions: Alternate forms allow serial testing without learning bias. Verbal fluency and logical memory tasks are sensitive to early cognitive changes.
A short screen for depression: the AB Clinician Depression Screen (ABCDS)
- D. William Molloy, Timothy I. Standish, Sacha Dubois, Alwin Cunje
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- Journal:
- International Psychogeriatrics / Volume 18 / Issue 3 / September 2006
- Published online by Cambridge University Press:
- 26 April 2006, pp. 481-492
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- Article
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Background: Depression is common in elderly people but physicians may not screen for it because of the length of time required by current screening instruments. We have developed a short screening instrument for depression for use in elderly people with normal cognition, mild cognitive impairment or early dementia.
Methods: Participants were aged 55 years or more, had scored 20 or more on the standardized Mini-mental State Examination (SMMSE) and had been referred to a specialist geriatric outpatient memory clinic. Scores on the 30-item Geriatric Depression Scale (GDS) were analyzed. A composite GDS score, consisting of the top five individual question scores that correlated to depression (GDS ≥ 14), were analyzed using a receiver operating curve analysis.
Results: There were 810 patients with SMMSE scores of 20 or greater, of whom 202 (24.9%) scored 14 or more on the GDS, indicating depression. GDS question 16, “Do you often feel downhearted and blue?,” had the highest correlation with the overall scores of 14 or more on the 30-point instrument (r = 0.64, p < 0.001). The next four questions with the highest correlates were Q10, “Do you often feel helpless?” (r = 0.56, p < 0.001), Q3, “Do you feel that your life is empty?” (r = 0.54, p < 0.001), Q9, “Do you feel happy most of the time?” (r = 0.52, p < 0.001), and Q1, “Are you basically satisfied with your life?” (r = 0.50, p < 0.001). The negative predictive value of “Do you often feel downhearted and blue?” answered negatively for depression was 96%. These five questions were used as a short screening instrument. The positive predictive value of four or five positive responses was 97%. These data were not significantly different whether the patient's SMMSE score was 20–25 or 26–30.
Conclusions: The AB Clinician Depression Screen (ABCDS), comprising five questions, can rapidly identify patients with depression or eliminate that diagnosis. In this population, these five questions may be used instead of the longer 30-question GDS scale.