Evidence for the Utility of Actuarial Neuropsychological Criteria Across the Continuum of Normal Aging, Mild Cognitive Impairment, and Dementia

Graves, Lisa V.; Edmonds, Emily C.; Thomas, Kelsey R.; Weigand, Alexandra J.; Cooper, Shanna; Bondi, Mark W.

doi:10.3233/jad-200778

Cited by 16 publications

(11 citation statements)

References 34 publications

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“…This is especially vital as poor diagnostic stability renders high reversion rates, poor identification of factors associated with reversion and dementia progression. One ultimate goal in MCI research is to achieve precise predictions for progression, in order to enable successful drug interventions [58]. Finally, our results express important aspects of daily social stimulation, the severity of the cognitive impairment, the role of alcohol consumption, BMI, and age on predicting the future path of those diagnosed with MCI.…”

Section: Discussionmentioning

confidence: 76%

Mild Cognitive Impairment, Reversion Rates, and Associated Factors: Comparison of Two Diagnostic Approaches

Overton

Sjögren

Elmståhl

et al. 2023

JAD

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Background: As mild cognitive impairment (MCI) is typically used to identify prodromal stages of dementia, it is essential to identify MCI criteria with high diagnostic stability and prediction of dementia. Moreover, further investigation into pinpointing key factors for reversion is required to foresee future prognosis of MCI patients accurately. Objective: To explore disparities in diagnostic stability by examining reversion rates produced by two operationalizations of the MCI definition: the widely applied Petersen criteria and a version of the Neuropsychological (NP) criteria and to identify cognitive, lifestyle, and health related factors for reversion. Methods: MCI was retrospectively classified in a sample from the Swedish community-based study Good Aging in Skåne with the Petersen criteria (n = 744, median follow-up = 7.0 years) and the NP criteria (n = 375, median follow-up, 6.7 years), respectively. Poisson regression models estimated the effect of various factors on the likelihood of incident reversion. Results: Reversion rates were 323/744 (43.4%, 95% confidence intervals (CI): 39.8; 47.0) and 181/375 (48.3% 95% CI: 43.2; 53.5) for the Petersen criteria and NP criteria, respectively. Participants with impairment in a single cognitive domain, regular alcohol consumption, living with someone, older age, and lower body mass index had a higher likelihood of reverting to normal. Conclusion: Reversion rates were similar for Petersen and NP criteria indicating that one definition is not superior to the other regarding diagnostic stability. Additionally, the results highlight important aspects such as multiple domain MCI, cohabitation, and the role of alcohol on predicting the trajectory of those diagnosed with MCI.

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Section: Discussionmentioning

confidence: 76%

Mild Cognitive Impairment, Reversion Rates, and Associated Factors: Comparison of Two Diagnostic Approaches

Overton

Sjögren

Elmståhl

et al. 2023

JAD

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“…These findings are consistent with recent work from our laboratory that compared actuarial vs consensus diagnoses using data from the NACC Uniform Data Set 40 ; we found that approximately one-third of individuals diagnosed as CN by consensus diagnosis met neuropsychological criteria for MCI. 41 Results of the current study have several important clinical and research implications. First, our findings show that the ADRC's method of consensus diagnosis underestimates MCI in its participant sample.…”

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

“…One potential explanation for underdiagnosis is that clinical judgment may reduce the likelihood of an MCI diagnosis if the participant and the study partner do not report concerns about cognitive or functional change, even in the presence of impaired neuropsychological test scores. Indeed, there is evidence that scores on the Clinical Dementia Rating (CDR) scale, a subjective measure of a participant's functioning, correspond more closely with consensus diagnoses than with performance on neuropsychological testing, 41 suggesting that the CDR is weighted more heavily than cognitive performance when determining consensus diagnoses. In addition, while the consensus method used by the ADRC/NACC includes consideration of a participant's neuropsychological performance, the final diagnostic decision may rely more heavily on measures of global cognition such as the MMSE, which is limited in its ability to distinguish CN from MCI 42 and typically does not show changes until later in the course of the disease.…”

Section: Discussionmentioning

confidence: 99%

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Data-Driven vs Consensus Diagnosis of MCI

et al. 2021

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Objective:Given prior work demonstrating that mild cognitive impairment (MCI) can be empirically differentiated into meaningful cognitive subtypes, we applied actuarial methods to comprehensive neuropsychological data from the University of California San Diego (UCSD) Alzheimer’s Disease Research Center (ADRC) in order to identify cognitive subgroups within nondemented ADRC participants, and to examine cognitive, biomarker, and neuropathological trajectories.Methods:Cluster analysis was performed on baseline neuropsychological data (n=738; mean age=71.8). Survival analysis examined progression to dementia (mean follow-up=5.9 years). CSF AD biomarker status and neuropathological findings at follow-up were examined in a subset with available data.Results:Five clusters were identified: “optimal” cognitively normal (CN; n=130) with above-average cognition, “typical” CN (n=204) with average cognition, non-amnestic MCI (naMCI; n=104), amnestic MCI (aMCI; n=216), and mixed MCI (mMCI; n=84). Progression to dementia differed across MCI subtypes (mMCI>aMCI>naMCI), with the mMCI group demonstrating the highest rate of CSF biomarker positivity and AD pathology at autopsy. Actuarial methods classified 29.5% more of the sample with MCI and outperformed consensus diagnoses in capturing those who had abnormal biomarkers, progressed to dementia, or had AD pathology at autopsy.Conclusions:We identified subtypes of MCI and CN with differing cognitive profiles, clinical outcomes, CSF AD biomarkers, and neuropathological findings over more than 10 years of follow-up. Results demonstrate that actuarial methods produce reliable cognitive phenotypes, with data from a subset suggesting unique biological and neuropathological signatures. Findings indicate that data-driven algorithms enhance diagnostic sensitivity relative to consensus diagnosis for identifying older adults at risk for cognitive decline.

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“…Maltreatment in the context of psychological assessment can take the form of diagnostic accuracy errors that result in overdiagnosis (Graves et al, 2020), particularly for historically minoritized older adults (Devlin et al, 2022). For example, there is a discrepancy between Black older adults compared to older white adults who meet classification for mild cognitive impairment instead of normal cognition when using demographically adjusted z scores (i.e., actuarial criteria) versus consensus criteria that incorporate screening measures, subjective cognitive and functional complaints, and clinician judgment (Graves et al, 2022).…”

Section: Maltreatment By the Medical Fieldmentioning

confidence: 99%

Culturally responsive psychological assessment with racially and ethnically diverse older adults.

Dixon¹,

Mather²,

Ready³

et al. 2023

Psychological Assessment

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The older adult population in the United States (U.S.) is becoming more racially and ethnically diverse, whereas most practicing neuropsychologists are white. Psychologists hold social privilege of which they may not be aware and work in health care systems that benefit the racial majority. System-level change is necessary to create a more equitable and accessible health care system for racially and ethnically diverse older adults. It is vital for the field of psychology to understand how oppression, power, and privilege impact the accessibility, reliability, and effectiveness of psychological assessment. The aim of this article is to address how historical medical injustices, poor education quality, barriers to communication, biases, and intersectionality influence psychological evaluations. Via a selective literature review, we illustrate how these issues apply to working with racially and ethnically diverse older adults. We discuss the historical context of the multicultural approach to assessment; system-and interpersonal-level manifestations of oppression; and age-cohort-related considerations. A clinical vignette illustrates how oppression, power, and privilege can manifest in the context of an evaluation. We issue a commentary and call to action, charging psychologists to implement individual-and system-level change. We provide recommendations for culturally responsive psychological assessments. Public Significance StatementThis article addresses how oppression, power, and privilege can occur in the psychological assessment with racially and ethnically diverse older adults. We provide recommendations for a culturally responsive approach to assessment.

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Evidence for the Utility of Actuarial Neuropsychological Criteria Across the Continuum of Normal Aging, Mild Cognitive Impairment, and Dementia

Cited by 16 publications

References 34 publications

Mild Cognitive Impairment, Reversion Rates, and Associated Factors: Comparison of Two Diagnostic Approaches

Mild Cognitive Impairment, Reversion Rates, and Associated Factors: Comparison of Two Diagnostic Approaches

Data-Driven vs Consensus Diagnosis of MCI

Culturally responsive psychological assessment with racially and ethnically diverse older adults.

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