Development of a Cognitive Screen Item Bank: Assessment of Individuals Across the Cognitive Spectrum, Including...

An item bank of cognitive items targeting the spectrum of cognitive function, with a focus on advanced dementia was developed with data from residents in long term services and supports (LTSS) settings. Latent variable models, including item response theory and factor analyses were applied to fifty items from multiple cognitive screening measures assessing memory, orientation, naming, attention, calculation, and following directions. Because the intent was to use the item bank to measure overall cognition, subdomains were not modeled. Factor analyses tested for essential unidimensionality, followed by application of an item response theory-based graded response model, including differential item functioning to examine measurement equivalence. The total sample size was 6,921, with 1,874 (27.1 %) males and 5,040 (72.9 %) females. The average age was 82.5 (SD = 11.0). There were 1,089 (16.2 %) Black, 498 (7.4 %) Hispanic, and 5,136 (76.4 %) White respondents. The average number of years of education was 9.1 (SD = 5.5). Estimates of reliability across age, education, race, and sex subgroups were high with most > 0.96. Cognitive function of the participants in the study varied from no to minimal impairment (552 or 8.0 %); mild (2,000 or 28.9 %); moderate (2,686 or 38.8 %); severe (1,328 or 19.2 %) to very severe impairment (355 or 5.1 %). Items with low information and substantial DIF were recommended for removal. The final recommended item bank includes 38 items. Future work with this item bank may include development of computerized adaptive tests and short-forms.