Clinical applicability and cutoff values for an unstructured neuropsychological assessment protocol for older adults with low formal education.
OBJECTIVE
The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use.


RESULTS
A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living.


CONCLUSIONS
The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.
Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil ; INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Jonas Jardim
JJ
de Paula
Laiss
L
Bertola
Rafaela Teixeira
RT
Ávila
Lafaiete
L
Moreira
Gabriel
G
Coutinho
Edgar Nunes
EN
de Moraes
Maria Aparecida Camargos
MA
Bicalho
Rodrigo
R
Nicolato
Breno Satler
BS
Diniz
Leandro Fernandes
LF
Malloy-Diniz
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis; D003072:Cognition Disorders / Q000175:diagnosis; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D012680:Sensitivity and Specificity