The Cognitive Assessment Interview (CAI): Reliability and Validity of a Brief Interview-Based Measure of Cognition

Abstract

Objective: To obtain Food and Drug Administration approval for the treatment of cognitive impairments associated with schizophrenia, a drug will need to demonstrate benefits beyond those that may be documented on objective cognitive tests. Interview-based measures of cognition such as the Cognitive Assessment Interview (CAI) are candidate coprimary outcome measures. Methods: Psychiatrically stable schizophrenia outpatients (n 5 150) were studied using the CAI to obtain information about cognitive functioning from both the patient and an informant. Patients also received objective assessments of neurocognition, functional capacity, functional outcome, and symptoms, at baseline and 1 month later. Results: The CAI had good internal consistency (Cronbach's alpha 5 .92) and good test-retest reliability (r 5 .83). The CAI was moderately correlated with objective neurocognitive test scores (r's 5 2.39 to 2.41) and moderately correlated with social functioning (r 5 2.38), work functioning (r 5 2.48), and overall functional outcome (r 5 2.49). The correlations of CAI scores with external validity indicators did not differ significantly by source of information (patient alone ratings were valid). Overall functional outcome correlated more strongly with patient CAI scores (r 5 2.50) than with objective neurocognitive test scores (r 5 .29) or functional capacity (r 5 .29). Conclusions: Field testing of the CAI produced reliable ratings of cognitive functioning that were correlated with functional outcome. Patient ratings alone yielded scores with reliability and validity values appropriate for use in clinical trials. The CAI appears to provide useful complementary information and possesses practical advantages for rating cognitive functioning including an interview-based method of administration, brief assessment time (15 min for the patient assessment), little or no practice effects, and ease of scoring.Key words: schizophrenia/functional outcome/functional capacity/symptoms/informant ratings/neurocognition IntroductionEvidence continues to accrue indicating that cognitive deficits are pronounced in schizophrenia and that those deficits impinge on a patient's quality of life and ability to function on a daily basis. Traditionally, objective tests have been used to assess cognition. But the assessment of cognitive functioning might benefit from nonperformance-based person-oriented assessments. Assessing cognitive functioning through interview-based methods is practical and might enable the examination of the impact of cognition on daily functioning. Interview-based measures of cognitive functioning are already in the second generation of development, following Food and Drug Administration (FDA) guidance on the development of methods for assessing patient reported outcomes.1-3 The assessment protocol for the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative included both of the first-generation instruments, the Schizophrenia Cognition Rating Scale (SCoRS) 2 and the Clinical Global ...

Reliability, validity and treatment sensitivity of the Schizophrenia Cognition Rating Scale

“…Previous reports suggested variable correlations between interview-based assessments and cognitive performance measures, ranging from −0.40 (Keefe et al, 2006) in a single site study to −0.31 in the 5-site MATRICS validation study (Green et al, 2008) with the SCoRS and −0.40 (Ventura et al, 2013) in a single site study to −0.23 in the 4-site MATRICS Validation of Intermediate Measures study (Green et al, 2011) with the CAI. The current data collected in a three-site research center consortium suggest that overall MCCB composite scores and SCoRS total ratings can have high correlations (r=0.46) when interviewers are highly trained and have access to reliable informants.…”

Self-assessment in schizophrenia: Accuracy of evaluation of cognition and everyday functioning.

“…For this study, we did not include the social cognition measure from the MCCB, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) because several recent meta-analyses (e.g., Fett et al, 2011; Ventura et al, 2013) found that social cognition measures are minimally correlated with neurocognitive test performance and that neurocognition and social cognition are associated with different outcomes. We calculated a composite score, an average of the 9 age-corrected T-scores based on the neurocognitive tests in the MCCB, using the MCCB normative program, as our critical dependent variable.…”

Factors influencing self-assessment of cognition and functioning in bipolar disorder: a preliminary study

“…We had patients and the high contact clinicians complete the Cognitive Assessment Inventory (CAI; Ventura et al, 2013). This is a 10-item instrument that asks the person making the judgments about cognition to rate severity of impairments in a variety of cognitive domains.…”

“…These research participants also provided self-reports regarding their current mood, and everyday functioning in three different functional domains with a previously validated rating scale (Schneier & Streuening, 1983). They completed a structured self-report assessment of cognitive performance (Ventura et al, 2013) and were examined with a metacognitive variant of the Wisconsin Card Sorting Test (Koren et al, 2004; 2005). High contact clinicians also generated identical functioning and cognitive performance ratings, while unaware of the patients’ performance on the assessment measures and their self-reports.…”