How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores

Abstract

Some older adults cannot meaningfully participate in the testing portion of a neuropsychological evaluation due to significant cognitive impairments. There are limited empirical data on this topic. Thus, the current study sought to provide an operational definition for a futile testing profile and examine cognitive severity status and cognitive screening scores as predictors of testing futility at both baseline and first follow‐up evaluations. We analysed data from 9,263 older adults from the National Alzheimer’s Coordinating Center Uniform Data Set. Futile testing profiles occurred rarely at baseline (7.40%). There was a strong relationship between cognitive severity status and the prevalence of futile testing profiles, χ2(4) = 3559.77, p < .001. Over 90% of individuals with severe dementia were unable to participate meaningfully in testing. Severity range on the Montreal Cognitive Assessment (MoCA) also demonstrated a strong relationship with testing futility, χ2(3) = 3962.35, p < .001. The rate of futile testing profiles was similar at follow‐up (7.90%). There was a strong association between baseline dementia severity and likelihood of demonstrating a futile testing profile at follow‐up, χ2(4) = 1513.40, p < .001. Over 90% of individuals with severe dementia, who were initially able to participate meaningfully testing, no longer could at follow‐up. Similarly, there was a strong relationship between baseline MoCA score band and likelihood of demonstrating a futile testing profile at follow‐up, χ2(3) = 1627.37, p < .001. Results can help to guide decisions about optimizing use of limited neuropsychological assessment resources.

Dispersion-based cognitive intra-individual variability in dementia with Lewy bodies.

“…Cognitive impairment was determined using the Clinical Dementia Rating (CDR) Dementia Staging Instrument Global Score, a reliable and valid measure that stages dementia using the following ratings: 0 = cognitively normal, 0.5 = mild cognitive impairment, 1 = mild dementia, 2 = moderate dementia, 3 = severe dementia (Fillenbaum et al, 1996; Morris, 1993). Individuals with moderate or severe dementia (i.e., CDR global score ≥ 2) were excluded from analyses because significant cognitive impairments often preclude meaningful participation in neurocognitive testing and differentiation of dementia etiologies (Kiselica, Johnson, & Benge, 2021; Salmon & Bondi, 2009). Of the included participants, 3,881 (64.9%) were classified as cognitively healthy, per CDR global score of 0.…”

A Novel Method for Establishing Functional Change in Older Adults With Cognitive Impairment

“…This may be of utility to clinicians working with advanced dementia, as current cognitive measures for tracking change become increasingly futile as individuals progress from mild dementia. 21 Unlike traditional neuropsychological tests in which an examinee can exhibit clinically significant score declines and/or improvements, there would be few scenarios in which…”

“…This hypothesis is supported by the AUCs, which meaningfully increase when discriminating those transitioning to, or from, mild dementia. This may be of utility to clinicians working with advanced dementia, as current cognitive measures for tracking change become increasingly futile as individuals progress from mild dementia 21…”

Ecological validity of cognitive fluctuations in dementia with Lewy bodies

“…Observations were provided from the outset of data collection through the June 2022 data freeze and included 167 participants from 6 Alzheimer’s Disease Research Centers across the United States of America who completed the MFS at their initial visit. Notably, we excluded participants with moderate to severe dementia using the Clinical Dementia Rating® (CDR) Dementia Staging Instrument Global Score (Fillenbaum et al, 1996; Morris, 1993) given evidence that significant cognitive impairments often preclude meaningful participation in neurocognitive testing and may contribute to floor-effects for the intraindividual variability-dispersion metrics (Kiselica & Benge, 2019; Kiselica et al, 2021; Salmon & Bondi, 2009). Additional exclusion criteria and the resulting final sample of 97 participants are depicted via STROBE (Strengthening the Reporting of OBservational studies in Epidemiology) diagram in Figure 1.…”