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Algorithm-defined memory impairment in older American Indians: The Strong Heart Study.

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An algorithm using the California Verbal Learning Test II-Short Form (CVLT-SF) identified memory deficits in American Indians. While moderately accurate, further refinement is needed for optimal dementia case identification.

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Area of Science:

  • Neuroscience
  • Gerontology
  • Public Health

Background:

  • Cognitive assessment in American Indians faces significant challenges, including healthcare access barriers and unvalidated clinical standards.
  • Algorithmic methods offer a promising alternative for identifying cognitive impairment, potentially surpassing clinical judgment in certain contexts.

Purpose of the Study:

  • To develop and evaluate an algorithmic approach for categorizing memory deficits in American Indians using a single cognitive test.
  • To assess the performance of this algorithm against a gold standard for dementia diagnosis.

Main Methods:

  • The California Verbal Learning Test II-Short Form (CVLT-SF) and clinical data were collected from 818 American Indians (aged 65-95) in 2010-2013, with a follow-up in 2017-2019.
  • An algorithm classified CVLT-SF scores into four memory deficit categories: none, encoding, storage, and retrieval.
  • Dementia diagnosis was established by consensus adjudication.

Main Results:

  • At baseline, memory deficits were observed in 24.6% of participants (15.6% encoding, 3.5% storage, 5.5% retrieval).
  • At follow-up, a significant proportion of participants with initial deficits were lost, and most new deficits emerged in previously unimpaired individuals.
  • The algorithm demonstrated moderate accuracy in classifying dementia (69% correct, 51% sensitivity, 91% specificity).

Conclusions:

  • This study presents a novel method for defining memory impairment in American Indians using a single cognitive test.
  • Further research is required to enhance the algorithm's sensitivity and utility for identifying cognitive impairment in this population.
  • These findings represent a crucial advancement toward improved cognitive assessment and dementia care for an understudied group.