Skip to main content Accessibility help
×
Home

COST: Cognitive State Test, a brief screening battery for Alzheimer disease in illiterate and literate patients

  • Gulsen Babacan-Yildiz (a1), Ahmet T. Isik (a2), Emel Ur (a3), Emine Aydemir (a2), Can Ertas (a4), Merve Cebi (a5), Pinar Soysal (a2), Esra Gursoy (a1), Mehmet Kolukisa (a1), Gulsen Kocaman (a1) and Arif Celebi (a1)...

Abstract

Background: The aim was to develop a brief screening battery, Cognitive State Test (COST), for detecting the presence of dementia in both illiterate and literate patients and to assess its validity and reliability.

Methods: COST is a cognitive screening tool that consists of almost all cognitive domains. It takes 5–7 minutes to administer, and has a maximum score of 30. Data were obtained from 114 healthy volunteers and 74 Alzheimer dementia (AD) patients. Subjects’ age divided into two groups: A1: <65 years; and A2: ≥65 years and their education level divided into three groups: E1: illiterate; E2: 1–5 years; and E3: ≥6 years. For assessing concurrent validity, total COST score was compared to the Clinical Dementia Rating (CDR), the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and Basic Activities of Daily Living (BADL). Sensitivity and specificity were determined through a discriminant analysis using the Receiver Operating Characteristic (ROC) curves. Internal consistency was measured using Cronbach's coefficient α.

Results: For normal and AD subjects, mean age was 64.9±9.8 years (50 women and 64 men) and 67.2±13.2 years (55 women and 19 men), respectively. Schooling ranged from 0–15 years (mean 5.7±4.2 and 3.3±3.8 years, respectively), and 21 and 37 subjects were illiterate, respectively. The COST significantly and positively correlated with MMSE and MoCA, and significantly and inversely correlated with CDR, the Geriatric Depression Scale (GDS), and BADL. In the E1, E2, and E3 education groups, the optimal cut-off points of COST chosen for diagnosis of AD were 23/24 (sensitivity: 81%, specificity: 99%), 24/25 (sensitivity: 75%, specificity: 86%), and 26/27 (sensitivity: 77%, specificity: 84%), respectively. When illiterate and literate subjects were then pooled, the optimal cut-off score of COST was 24/25, which yielded a sensitivity of 81% and a specificity of 87%. Reliability of the COST was good (0.86).

Conclusion: The COST is a valid and reliable screening battery for detection of dementia both in the illiterate and the literate Alzheimer patients.

Copyright

Corresponding author

Correspondence should be addressed to: Gulsen Babacan-Yildiz, Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih 34093 Istanbul, Turkey. Phone: +90 554 915 55 11; Fax: +90 212 533 23 26. Email: gbabacan@hotmail.com.

References

Hide All
American Psychiatric Association (1994). Diagnostic and Statistical Manual for Mental Disorders, 4th edn, revised., pp. 133155. Washington, DC: American Psychiatric Association.
Breen, A. R., Larson, E. B., Reifler, B. V., Vitaliano, P. P. and Lawrence, G. L. (1984). Cognitive performance and functional competence in coexisting dementia and depression. Journal of the American Geriatrics Society, 32, 132137.
Corrada, M. M., Brookmeyer, R., Paganini-Hill, A., Berlau, D. and Kawas, C. H. (2010). Dementia incidence continues to increase with age in the oldest old: the 90 study. Annals of Neurology, 67, 114121.
Escobar, J. I., Burnam, A., Karno, M.et al. (1986). Use of the mini-mental state examination (MMSE) in a community population of mixed ethnicity. The Journal of Nervous and Mental Disease, 174, 607614.
Ertan, T., Eker, E., Gungen, C.et al. (1999). The Standardized Mini-Mental State Examination for Illiterate Turkish Elderly Population. Paper presented at 2nd International Symposium on Neurophysiological and Neuropsychological Assessment of Mental and Behavioral Disorders, August 28–30, Kirazliyayla, Bursa, Turkey.
Evans, D. A., Funkenstein, H. H., Albert, M. S., Scherr, P. A., Cook, N. R.et al. (1989). Prevalence of Alzheimer's disease in a community population of older persons: higher than previously reported. JAMA, 262, 25512556.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Galasko, D., Bennett, D., Sano, M., Ernesto, C., Thomas, R.et al. (1997). An inventory to assess activities of daily living for clinical trials in Alzheimer's disease. The Alzheimer's disease cooperative study. Alzheimer Disease and Associated Disorders, 11 (Suppl. 2), S3339.
Geldmacher, D. S. and Whitehouse, P. J. Jr (1997). Differential diagnosis of Alzheimer's disease. Neurology, 48, 4349.
Gungen, C., Ertan, T., Eker, E., Yasar, R. and Engin, F. (2002). Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population. Turk Psikiyatri Dergisi, 13, 273281.
Hannay, H. J. and Lezak, M. D. (2004). The neuropsychological examination: interpretation. In Lezak, M. D., Howieson, B., Loring, D. W. (eds.), Neuropsychological Assessment (4th edn, pp. 133156). New York: Oxford University Press.
Hughes, C. P., Berg, L., Danziger, W. L.et al. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572.
Katz, S., Ford, A. B., Moskowitz, R. W.et al. (1963). Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA, 185, 914919.
Kalaria, R. N., Maestre, G. E., Arizaga, R., Friedland, R. P., Galasko, D. et al. (2008). World Federation of Neurology Dementia Research Group Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurology, 7, 812826.
Kraemer, H. C., Moritz, D. J. and Yesavage, J. (1998). Adjusting Mini-Mental State Examination scores for age and educational level to screen for dementia: correcting bias or reducing validity? International Psychogeriatrics, 10, 4351.
Lechowski, L., de Stampa, M., Denis, B., Tortrat, D., Chassagne, P.et al. (2008). Patterns of loss of abilities in instrumental activities of daily living in Alzheimer's disease: the REAL cohort study. Dementia and Geriatric Cognitive Disorders, 25, 4653.
Lee, J. Y., Chang, S. M., Jang, H. S., Chang, J. S., Suh, G. H.et al. (2008). Illiteracy and the incidence of Alzheimer's disease in the Yonchon County survey, Korea. International Psychogeriatrics, 20, 976985.
Lezak, M. D., Howieson, D. B. and Loring, D. W. (2004). Neuropsychological Assessment, 4th edn.Oxford, England: Oxford University Press.
Loewenstein, D. A., Amigo, A., Duara, R., Gutterman, A. and Hurwitz, D. (1989). A new scale for the assessment of functional status in Alzheimer's disease and related disorders. Journal of Gerontology, 44, 114121.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.
Nasreddine, Z. S., Philips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V.et al. (2005). The Montreal Cognitive Assessment, MOCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695699.
Prencipe, M., Casini, A. R., Ferretti, C., Lattanzio, M. T. and Fiorelli, M. (1996). Prevalence of dementia in an elderly rural population: effects of age, sex, and education. Journal of Neurology, Neurosurgery and Psychiatry, 60, 628633.
Scazufca, M., Almeida, O. P., Vallada, H. P., Tasse, W. A. and Menezes, P. R. (2009). Limitations of the Mini-Mental State Examination for screening dementia in a community with low socioeconomic status: results from the Sao Paulo Ageing & Health Study. European Archives of Psychiatry and Clinical Neuroscience, 259, 815.
Selekler, K., Cangoz, B. and Uluc, S. (2010). Montreal bilişsel değerlendirme ölçeğinin hafif bilişsel bozukluk ve Alzheimer hastalarını ayırt edebilme gücünün incelenmesi. Turkish Journal of Geriatrics, 13, 166171.
Teng, E. L. (2002). Culture and educational factors in the diagnosis of dementia. Alzheimer Disease and Associated Disorders, 16 (Suppl. 2), S77S79.
Tombaugh, T. N. and McIntyre, N. J. (1992). The Mini-Mental State Examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922935.
Turkstat (2011). Turkish Statistical Institute. Results of Adult Education Survey.
Wilson, R. S., Mendes-DeLeon, C. F., Bennett, D. A., Bienias, J. L. and Evans, D. A. (2004). Depressive symptoms and cognitive decline in a community population of older persons. Journal of Neurology, Neurosurgery and Psychiatry, 75, 126129.
Yassuda, M. S., Diniz, B. S., Flaks, M. K., Viola, L. F., Pereira, F. S.et al. (2009). Neuropsychological profile of Brazilian older adults with heterogeneous educational backgrounds. Archives of Clinical Neuropsychology, 24, 7179.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V.et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749.

Keywords

COST: Cognitive State Test, a brief screening battery for Alzheimer disease in illiterate and literate patients

  • Gulsen Babacan-Yildiz (a1), Ahmet T. Isik (a2), Emel Ur (a3), Emine Aydemir (a2), Can Ertas (a4), Merve Cebi (a5), Pinar Soysal (a2), Esra Gursoy (a1), Mehmet Kolukisa (a1), Gulsen Kocaman (a1) and Arif Celebi (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed