Adaptive Cognitive Testing in Cerebrovascular Disease and Vascular Dementia

Abstract

Background/Aims: To examine whether brevity can be combined with precision in measuring global cognitive ability in patients with cerebrovascular disease (CVD) or vascular dementia (VaD). Longer tests (e.g. the CAMCOG) are precise but inefficient, whereas brief tests (e.g. the MMSE) are efficient but imprecise. Methods: A simulated computerized adaptive testing (CAT) algorithm using existing CAMCOG data from 284 patients with CVD of whom 55 were diagnosed with VaD. CAT was used to estimate each individual patient’s total score on a large precise test (the CAMCOG). CAT repeatedly selected only items of appropriate difficulty, depending on whether the previous item was (in)correctly responded to. CAT estimates were compared with total scores on the whole CAMCOG. Results: Even though there was an average test reduction of more than 40%, CAT estimates were in very high agreement with the whole test results (intraclass correlation >0.97) and had similar accuracy for the diagnosis of dementia (area under the curve = 0.94). Conclusion: CAT combines efficiency with precision in the measurement of global cognitive ability in CVD patients.

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment*

“…A computerized approach has the additional advantage of greatly simplifying the process of administering a test in an adaptive format, automatically selecting the next items to be administered based on the pattern of previous responses and stopping once a criterion is reached for confidence in the accuracy of the resulting score. This approach has been used successfully to evaluate cognition in patients with cerebrovascular disease [41] and in a rehabilitation clinic population [42]. Secondly, the particular computer tests we used are drawn from the experimental cognitive neuroscience literature, and so have not undergone the extensive normative testing of more conventional measures.…”

Computerized Neuropsychological Assessment Devices: Joint Position Paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology

“…Examples include children with attention-deficit hyperactivity disorder (Bolfer et al, 2010; Chamberlain et al, 2011; Gualtieri & Johnson, 2006; Polderman, van Dongen, & Boomsma, 2011) or depression (Brooks, Iverson, Sherman, & Roberge, 2010); adults with psychiatric illnesses, such as depression or bipolar disorder (Iverson, Brooks, Langenecker, & Young, 2011; Sweeney, Kmiec, & Kupfer, 2000); and adolescents and young adults who sustain sport-related concussions (Bleiberg, Garmoe, Halpern, Reeves, & Nadler, 1997; Bleiberg et al, 2004; Broglio, Ferrara, Macciocchi, Baumbartner, & Elliott, 2007; Cernich, Reeves, Sun, & Bleiberg, 2007; Collie, Makdissi, Maruff, Bennell, & McCrory, 2006; Collins, Lovell, Iverson, Ide, & Maroon, 2006; Gualtieri & Johnson, 2008; Iverson, Brooks, Collins, & Lovell, 2006; Iverson, Brooks, Lovell, & Collins, 2006; Peterson, Stull, Collins, & Wang, 2009; Van Kampen, Lovell, Pardini, Collins, & Fu, 2006). CNADs have also been applied to adult epilepsy (Moore, McAuley, Long, & Bornstein, 2002), cardiovascular surgery (Raymond, Hinton-Bayre, Radel, Ray, & Marsh, 2006), neurocognitive problems encountered by active duty military service members and veterans (Anger et al, 1999; Marx et al, 2009; McLay, Spira, & Reeves, 2010; Retzlaff, Callister, & King, 1999; Vasterling et al, 2006), and mild cognitive impairment in older adults (Doniger et al, 2006; Dwolatzky et al, 2004; Gualtieri & Johnson, 2005; Tornatore, Hill, Laboff, & McGann, 2005; Wild, Howieson, Webbe, Seelye, & Kaye, 2008) or dementia (Doniger et al, 2005; Dorion et al, 2002; Wouters, de Koning et al, 2009; Wouters, Zwinderman, van Gool, Schmand, & Lindeboom, 2009). Computerized tests, sometimes administered as part of a predominantly examiner-administered battery, are also used to identify poor effort within the context of a comprehensive neuropsychological evaluation (Green, Rohling, Lees-Haley, & Allen, 2001; Slick et al, 2003).…”

Individualized evaluation of cholinesterase inhibitors effects in dementia with adaptive cognitive testing

“…Consistent with previous findings (Wouters et al ., , , ), the results of this study support the potential of adaptive cognitive testing to establish an optimal trade‐off between precision and brevity. A substantial test reduction of about 60% was observed for the adaptive C‐47 compared to the whole C‐47 (47 CAMCOG item set).…”

“…A previously validated CAT algorithm (Wouters et al, 2009a(Wouters et al, , 2009b(Wouters et al, , 2011Lindeboom et al, 2004) was examined. Item difficulties of the CAT algorithm were fixed according to the item difficulties of a validated set of 47 CAMCOG items previously published (Lindeboom et al, 2004).…”

“…Adaptive testing has the potential to considerably shorten extensive cognitive tests and to make them much more patient-friendly and feasible for routine administration in outpatient settings. Our previous research (Wouters et al, 2009a(Wouters et al, , 2009b(Wouters et al, , 2011 showed that adaptive testing indeed combines precision with feasibility. Compared to the whole test, test reductions of up to 40% to 60% were found with only slight loss of precision.…”