Potential for misclassification of mild cognitive impairment: A study of memory scores on the Wechsler Memory Scale-III in healthy older adults

Brooks, Brian L.; Iverson, Grant L.; Holdnack, James A.; Feldman, Howard

doi:10.1017/s1355617708080521

Cited by 144 publications

(161 citation statements)

References 62 publications

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“…Second, there is no consensus regarding which neuropsychological tests are most effective in identifying MCI. By using a cut off of ≤ 1.5 standard deviation units we attempted to guard against a type 1 error; however, by permitting a low score on any of six tests, we acknowledge the possibility of making a type 2 error (Brooks, Iverson, & White, 2007 ;Brooks, Grant, Holdnack, & Feldman, 2008 ). Indeed, our rates of discrimination are slightly lower than base rates of low memory performance in older community dwelling adults (Brooks et al, 2007 ), but slightly higher than those reported in large-scale epidemiological studies of pathological aging in patients followed through a memory disorders clinic (Edwards, Lindquist, & Yaffe, 2004 ).…”

Section: Discussionmentioning

confidence: 99%

The heterogeneity of mild cognitive impairment: A neuropsychological analysis

Libon

Xie

Eppig

et al. 2009

J Int Neuropsychol Soc

114

122

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A group of 94 nondemented patients self-referred to an outpatient memory clinic for memory diffi culties were studied to determine the incidence of single versus multi-domain mild cognitive impairment (MCI) using Petersen criteria. Fifty-fi ve community dwelling normal controls (NC) participants without memory complaints also were recruited. Tests assessing executive control, naming/lexical retrieval, and declarative memory were administered. Thirty-four patients exhibited single-domain MCI, 43 patients presented with multi-domain MCI. When the entire MCI sample ( n = 77) was subjected to a cluster analysis, 14 patients were classifi ed with amnesic MCI, 21 patients with dysexecutive MCI, and 42 patients were classifi ed into a mixed/multi-domain MCI group involving low scores on tests of letter fl uency, "animal" fl uency, and delayed recognition discriminability. Analyses comparing the three cluster-derived MCI groups versus a NC group confi rmed the presence of memory and dysexecutive impairment for the amnesic and dysexecutive MCI groups. The mixed MCI group produced lower scores on tests of letter fl uency compared with the amnesic MCI and NC groups and lower scores on tests of naming and memory compared with the NC group. In summary, multi-domain MCI is quite common. These data suggest that MCI is a highly nuanced and complex clinical entity. ( JINS , 2010, 16, 84-93.)

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Section: Discussionmentioning

confidence: 99%

The heterogeneity of mild cognitive impairment: A neuropsychological analysis

Libon

Xie

Eppig

et al. 2009

J Int Neuropsychol Soc

114

122

View full text Add to dashboard Cite

show abstract

“…The domains assessed were Memory (CVLT-II, WMS-III Logical Memory, WMS-R Verbal Paired Associates, WMS-R Visual Paired Associates, WMS-III Faces, and Rey Figure Recall), Language (Phonemic Fluency, Semantic Fluency, Boston Naming Test), Visual-Spatial (WASI Block Design, Rey Figure Copy), and Executive (Trail Making Test Part B, Wisconsin Card Sorting Task). Requiring two or more tests within a domain to be impaired within a domain reduces the likelihood of false positive identification of MCI [18]. Based on this test battery, four individuals had single-domain amnestic MCI, two had single-domain non-amnestic MCI, and four had multi-domain amnestic MCI.…”

Section: Participants and Methodsmentioning

confidence: 99%

Mild Cognitive Impairment Is Associated with Impaired Visual-Motor Planning When Visual Stimuli and Actions Are Incongruent

2011

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Background/Aims: This study examined cognitive-motor integration in adults with mild cognitive impairment (MCI). Previously, we showed that the performance of early-stage Alzheimer’s disease patients declined significantly as a visually-guided movement went from having a standard mapping (vision and action spatially aligned) to having a non-standard mapping (vision and action incongruent). The present study extends this line of research by examining the performance of individuals affected by MCI. Methods: The participants made finger movements over a clear touchscreen placed in two separate spatial planes to either constantly present or remembered visual targets. These spatial plane conditions were repeated with the direction of cursor motion rotated 180° from that of hand motion. We also tested an ‘arbitrary’ condition where symbols instructed the participants to move their hand in certain directions. Results: We observe that adults with MCI took significantly longer to plan movements requiring intermediate levels of non-standard mapping, relative to healthy older adults. Conclusions: These data suggest that movements requiring rule integration is affected even in individuals at a very early stage of cognitive decline. Cognitive-motor integration may provide a sensitive means to detect functional difficulty in early cognitive impairment.

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“…Because healthy older adults may obtain some low memory scores [18] there is substantial concern regarding false-positive diagnosis of memory impairment [19][20][21][22][23] . If memory impairment is misdiagnosed [see ref.…”

Section: Introductionmentioning

confidence: 99%

Minimizing Misdiagnosis: Psychometric Criteria for Possible or Probable Memory Impairment

Brooks¹,

Iverson

Feldman

et al. 2009

Dement Geriatr Cogn Disord

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Background/Aims: Memory impairment can be easily misdiagnosed in older adults because obtaining some low scores is common. The objective of the present study is to present new psychometric criteria for determining ‘possible’ and ‘probable’ memory impairment. Methods: We propose criteria based on an analysis of performance from 450 healthy older adults (55–87 years old) on 3 measures from the WMS-III: Logical Memory, Word List, and Visual Reproduction. These measures yield 8 age-adjusted scores for learning, recall, and recognition. The proposed criteria for memory impairment are based on the prevalence of low scores when simultaneously examining all 8 scores and are stratified by current intelligence, estimated premorbid intelligence, and education. The criteria are subsequently validated on 100 healthy older adults and 34 patients with ‘possible’ or ‘probable’ Alzheimer’s Disease (AD). Results: Tables with cutoffs and false-positive rates are presented for clinical use. In the validation cohort there were no misclassifications in AD patients. Conclusion: This study presents steps in the development of proposed psychometric criteria that, in conjunction with clinical judgment, could minimize the misdiagnosis of memory impairment. It is important to reduce misdiagnosis in order to (a) optimize patient care, (b) provide an accurate foundation for identifying biological and neurological markers, and (c) successfully develop disease-modifying treatments. Further validation in a sample of older adults with lesser degrees of cognitive impairment is needed.

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Potential for misclassification of mild cognitive impairment: A study of memory scores on the Wechsler Memory Scale-III in healthy older adults

Cited by 144 publications

References 62 publications

The heterogeneity of mild cognitive impairment: A neuropsychological analysis

The heterogeneity of mild cognitive impairment: A neuropsychological analysis

Mild Cognitive Impairment Is Associated with Impaired Visual-Motor Planning When Visual Stimuli and Actions Are Incongruent

Minimizing Misdiagnosis: Psychometric Criteria for Possible or Probable Memory Impairment

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