title: Can the CAMCOG be a good cognitive test for patients with Alzheimer's disease with low levels of education?
abstract: BACKGROUND
  The Cambridge Cognitive Examination (CAMCOG) is a useful test in screening for Alzheimer's disease (AD). However, the interpretation of CAMCOG cut-off scores is problematic and reference values are needed for different educational strata. Given the importance of earlier diagnoses of mild dementia, new cut-off values are required which take into account patients with low levels of education. This study aims to evaluate whether the CAMCOG can be used as an accurate screening test among AD patients and normal controls with different educational levels.
  
  
  METHODS
  Cross-sectional assessment was undertaken of 113 AD and 208 elderly controls with heterogeneous educational levels (group 1: 1-4 years; group 2: 5-8 years; and group 3: ≥ 9 years) from a geriatric clinic. submitted to a thorough diagnostic evaluation for AD including the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). Controls had no cognitive or mood complaints. Sensitivity (SE) and specificity (SP) for the CAMCOG in each educational group was assessed with receiver-operator-characteristic (ROC) curves.
  
  
  RESULTS
  CAMCOG mean values were lower when education was reduced in both diagnostic groups (controls - group 1: 87; group 2: 91; group 3: 96; AD - group 1: 63; group 2: 62; group 3: 77). Cut-off scores for the three education groups were 79, 80 and 90, respectively. SE and SP varied among the groups (group 1: 88.1% and 83.5%; group 2: 84.6% and 96%; group 3: 70.8% and 90%).
  
  
  CONCLUSIONS
  The CAMCOG can be used as a cognitive test for patients with low educational level with good accuracy. Patients with higher education showed lower scores than previously reported.
authors.affiliation: Psychogeriatric Unit, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil. ivan.aprahamian@terra.com.br
authors.forename: Ivan
authors.initials: I
authors.lastname: Aprahamian
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Martinelli
authors.forename: Juliana
authors.initials: J
authors.lastname: Cecato
authors.forename: Rafael
authors.initials: R
authors.lastname: Izbicki
authors.forename: Mônica Sanches
authors.initials: MS
authors.lastname: Yassuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis*; D003071:Cognition; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D009483:Neuropsychological Tests; D012680:Sensitivity and Specificity