Conventional and robust norming in identifying preclinical dementia.
OBJECTIVE
To contrast four approaches to norming two widely used memory tests in older adults for the purpose of detecting preclinical dementia.


METHODS
The study sample included participants from the Einstein Aging Study who were over age 70, were free of dementia at baseline, and were followed for at least 5 years. Norms were derived from a conventional sample (excluding individuals with dementia at baseline but not those who developed dementia during follow-up) and a robust normative sample (excluding persons with dementia at baseline as well as those who developed dementia over 5 years of follow-up). Both normative samples were examined with and without adjustment for age and education. We contrasted the picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) and the Logical Memory (LM) test for their ability to identify persons with preclinical dementia, operationally defined by the development of diagnosable dementia over 5 years of follow-up, using these four approaches to developing norms for detecting preclinical dementia.


RESULTS
Of 418 participants included in the conventional normative sample, the mean age was 78.2 years, and 59% were female. There were 78 incident cases of dementia over 5 years leaving 340 participants in the robust normative sample. Means and standard deviations were defined for both the conventional and robust normative samples, and cut-scores with and without adjustment were set at 1.5 standard deviations below the mean of each test. As predicted, in comparison with the conventional sample, the robust sample had higher cut-scores, which provided higher sensitivity for detecting preclinical dementia. This effect persisted regardless of adjustment. The pFCSRT+IR was more sensitive than LM in detecting incident dementia cases.


CONCLUSIONS
When using cognitive test norms to identify preclinical dementia, robust norming procedures improves detection using both the pFCSRT+IR and LM.
a Department of Neurology and the Einstein Aging Study , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
Ellen
E
Grober
b Department of Epidemiology and Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
Wenzhu
W
Mowrey
a Department of Neurology and the Einstein Aging Study , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
Mindy
M
Katz
a Department of Neurology and the Einstein Aging Study , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
Carol
C
Derby
a Department of Neurology and the Einstein Aging Study , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.|b Department of Epidemiology and Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
Richard B
RB
Lipton
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D015331:Cohort Studies; D003463:Cues; D003704:Dementia / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012016:Reference Values
Free and Cued Selective Reminding Test; Incident dementia; Logical memory; Memory; Mild cognitive impairment; Preclinical dementia; Robust and conventional norms