Screening for cognitive impairment in older individuals. Validation study of a computer-based test.
OBJECTIVE
This study examined the validity of a computer-based cognitive test that was recently designed to screen the elderly for cognitive impairment.


METHODS
Criterion-related validity was examined by comparing test scores of impaired patients and normal control subjects. Construct-related validity was computed through correlations between computer-based subtests and related conventional neuropsychological subtests.


METHODS
University center for memory disorders.


METHODS
Fifty-two patients with mild cognitive impairment by strict clinical criteria and 50 unimpaired, age- and education-matched control subjects. Control subjects were rigorously screened by neurological, neuropsychological, imaging, and electrophysiological criteria to identify and exclude individuals with occult abnormalities.


RESULTS
Using a cut-off total score of 126, this computer-based instrument had a sensitivity of 0.83 and a specificity of 0.96. Using a prevalence estimate of 10%, predictive values, positive and negative, were 0.70 and 0.96, respectively. Computer-based subtests correlated significantly with conventional neuropsychological tests measuring similar cognitive domains. Thirteen (17.8%) of 73 volunteers with normal medical histories were excluded from the control group, with unsuspected abnormalities on standard neuropsychological tests, electroencephalograms, or magnetic resonance imaging scans.


CONCLUSIONS
Computer-based testing is a valid screening methodology for the detection of mild cognitive impairment in the elderly, although this particular test has important limitations. Broader applications of computer-based testing will require extensive population-based validation. Future studies should recognize that normal control subjects without a history of disease who are typically used in validation studies may have a high incidence of unsuspected abnormalities on neurodiagnostic studies.
Green
R C
RC
Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Ga.
Green
J
J
Harrison
J M
JM
Kutner
M H
MH
D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D009483:Neuropsychological Tests; D015203:Reproducibility of Results