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Published on: June 25, 2019
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Predictors of dementia misclassification when using brief cognitive assessments.
Janice M Ranson1, Elżbieta Kuźma1, William Hamilton1
1University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan.
Neurology. Clinical Practice
|May 2, 2019
Summary
Brief cognitive assessments like MMSE, MIS, and AN can misclassify dementia. Absence of informant-rated poor memory is a key predictor of misclassification across these tests.
Area of Science:
- Gerontology
- Cognitive Neuroscience
- Psychometrics
Background:
- Brief cognitive assessments are prone to misclassifying dementia, leading to inaccurate diagnoses.
- The Mini-Mental State Examination (MMSE), Memory Impairment Screen (MIS), and animal naming (AN) are commonly used brief cognitive tests.
- Understanding predictors of misclassification is crucial for improving diagnostic accuracy in older adults.
Purpose of the Study:
- To identify predictors of false-negative, false-positive, and overall misclassification by the MMSE, MIS, and AN.
- To analyze sociodemographic factors, dementia risk factors, and test bias sources as potential predictors.
- To elucidate patterns of misclassification specific to each brief cognitive assessment.
Main Methods:
- Utilized data from 824 older adults in the US Aging, Demographics and Memory Study.
- Employed adjudicated dementia diagnosis (DSM-III-R and DSM-IV) as the reference standard.
- Applied multivariate bootstrapped fractional polynomial regression models to analyze predictors for each assessment's misclassification.
Main Results:
- Misclassification by at least one test occurred in 35.7% of participants; only 1.7% were misclassified by all three.
- Years of education predicted higher false-negatives and lower false-positives on the MMSE.
- Nursing home residency predicted lower false-negatives and higher false-positives on AN.
- Absence of informant-rated poor memory consistently predicted false-negatives and overall misclassification across assessments.
- Age, nursing home residency, and non-Caucasian ethnicity consistently predicted false-positives.
Conclusions:
- Brief cognitive assessments frequently misclassify dementia, primarily due to assessment-specific biases.
- Identifying specific predictors can help mitigate misclassification errors in clinical practice.
- Further research into test-specific biases is warranted to enhance dementia diagnostic tools.
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