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Development of a method for quantifying cognitive ability in the elderly through adaptive test administration

Published online by Cambridge University Press:  04 April 2011

Susanna Konsztowicz ,
Haiqun Xie ,
Johanne Higgins ,
Nancy Mayo  and
Lisa Koski
Susanna Konsztowicz
Affiliation:
Integrated Program in Neuroscience, Department of Neurology and Neurosurgery, McGill University
Haiqun Xie
Affiliation:
Division of Experimental Medicine, Department of Medicine, McGill University
Johanne Higgins
Affiliation:
School of Rehabilitation, Faculty of Medicine, University of Montreal, Canada
Nancy Mayo
Affiliation:
Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre
Lisa Koski*
Affiliation:
Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre Division of Geriatrics, Research Institute of the McGill University Health Centre
*
Correspondence should be addressed to: Dr. Lisa Koski, Royal Victoria Hospital, R4.74, 687 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada. Phone: +1 (514) 934-1934 ext. 35652; Fax: +1 (514) 934-1934 ext. 31734. Email: lisa.koski@mcgill.ca.
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Abstract

Background: The field of geriatric medicine has identified a need for an evaluative tool that can rapidly quantify global cognitive ability and accurately monitor change over time in patients with a wide range of impairments. We hypothesized that the development of an adaptive test approach to cognitive measurement would help to meet that need. This study aimed to provide evidence for the interpretability of scores obtained from a novel, adaptive approach to cognitive assessment, called the Geriatric Rapid Adaptive Cognitive Estimate (GRACE) method.

Methods: An adaptive method for cognitive assessment was developed using data from 185 patients referred for geriatric cognitive assessment, and pilot tested in an additional 137 patients. Correlations between test scores and between rank orders of patients were computed to examine the reliability and validity of cognitive ability scores obtained by (1) administering test questions out of their usual order, (2) administering only a subset of questions, and (3) administering questions adaptively using simplified selection rules based on the most difficult question passed.

Results: Cognitive ability scores obtained with the GRACE method correlated highly with the Montreal Cognitive Assessment (MoCA) scores (r = 0.93) and ranked patients similarly in order of ability (r > 0.87). A simplified adaptive testing algorithm for pencil-and-paper assessment demonstrated moderately high correlations with scores obtained from administering the full set of MMSE and MoCA items as well as the MoCA items alone.

Conclusions: Scores from the GRACE method can be obtained easily in 5–10 minutes, reducing test burden. The resulting numeric score quantifies cognitive ability, allowing clinicians to compare patients and monitor change in global cognition over time. The adaptive nature of this method allows for evaluation of persons across a broader range of cognitive ability levels than currently available tests.

Keywords

GRACE methodMoCAMMSERasch analysisassessmentgeriatricaging
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 7 , September 2011 , pp. 1116 - 1123
Copyright
Copyright © International Psychogeriatric Association 2011

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