The abbreviated form of the Brief Cognitive Battery in the diagnosis of dementia in Alzheimer's disease

Castro, Stephanie; Damin, Antonio Eduardo; Porto, Cláudia Sellitto; Caramelli, Paulo; Nitrini, Ricardo

doi:10.1590/S1980-57642009DN30400011

Abstract

The Brief Cognitive Battery (BCB) developed by our group for cognitive assessment of low educated individuals has also shown to be highly accurate in diagnosing dementia of individuals with medium or high levels of education, making it a useful tool for populations with heterogeneous educational background. The application of BCB takes around eight minutes, a rather long period for a screening test. Objectives: Our aim was to evaluate whether the exclusion of items of the BCB could reduce its application time without losing accuracy. Methods: Patients with Alzheimer's disease with mild or moderate dementia (N=20), and 30 control subjects were submitted to an abbreviated version of the BCB in which the clock drawing test was not included as an interference test for the delayed recall test. Data from another 22 control individuals who were submitted to the original BCB in another study were also included for comparison. A mathematical formula was employed to compare the two versions of the BCB. Descriptive statistics and ROC (receiver operator characteristic) curves were used (alpha=0.05). Results: Using the abbreviated version, the delayed recall test also had high accuracy in diagnosing dementia and the mathematical formula results did not differ to those obtained using the original version, while mean time was reduced by 2 minutes and 37 seconds. Conclusions: This abbreviated form of the BCB is a potentially valuable tool for screening dementia in population studies as well as in busy clinical practices in countries with heterogeneous educational backgrounds.

Key words:
Alzheimer's disease; dementia; diagnosis; education; brief cognitive battery; neuropsychological tests.

Resumo

A Bateria Cognitiva Breve (BCB), desenvolvida pelo nosso grupo para a avaliação cognitiva de indivíduos de baixa escolaridade, tem se mostrado também bastante precisa no diagnóstico de demência em indivíduos com escolaridade média ou alta, tornando-se uma ferramenta útil para populações com heterogeneidade educacional. A aplicação da BCB demora cerca de oito minutos, um tempo bastante longo para um teste de rastreio cognitivo.

Objetivos:

Avaliar se a exclusão de itens da BCB pode reduzir o tempo de aplicação, sem perder precisão.

Métodos:

Pacientes com doença de Alzheimer com demência leve ou moderada (N=20) e 30 indivíduos controle foram submetidos a uma versão abreviada da BCB na qual o teste do desenho do relógio não foi incluído como um teste de interferência para o teste de recordação tardia. Dados de outros 22 indivíduos controle que haviam sido submetidos à BCB original em um outro estudo foram incluídos para comparação. Uma fórmula matemática também foi empregada para comparação entre as duas versões da BCB. Estatísticas descritivas e curvas ROC (receiver operator characteristic) foram utilizadas e admitiu-se alfa=0,05.

Resultados:

Com a versão abreviada, o teste de recordação tardia também teve alta acurácia no diagnóstico de demência, os resultados das fórmulas matemáticas não foram diferentes daqueles obtidos com a versão original, e o tempo médio foi reduzido em 2 minutos e 37 segundos.

Conclusões:

Esta forma abreviada da BCB é uma ferramenta potencialmente útil para o rastreio de demência em estudos populacionais, bem como para o emprego em prática clínica em países em que há grande heterogeneidade educacional.

Palavras-chave:
doença de Alzheimer; demência; diagnóstico; educação; bateria cognitiva breve; testes neuropsicológicos.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Herrera Jr. E, Caramelli P, Silveira AS, Nitrini R. Epidemiological survey of dementia in a community dwelling population. Alzheimer Dis Assoc Disord 2002;16:103-108.
²
Vasconcelos LG, Brucki SMD, Bueno OFA. Cognitive and functional dementia assessment tools. Dement Neuropsychol 2007;1:18-23.
³
Folstein MF, Folstein SE, McHugh PR. "Mini-mental State": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
⁴
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
⁵
Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
⁶
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.
⁷
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico das demências. Arq Neuropsiquiatr 1994;52:457-465.
⁸
Nitrini R, Caramelli P, Herrera Jr E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.
⁹
Takada LT, Caramelli P, Charchat HF, et al. Comparison between two tests of delayed recall for the diagnosis of dementia. Arq Neuropsiquiatr 2006;64:35-40.
¹⁰
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36.
¹¹
Nitrini R, Caramelli P, Porto CS, et al. Uma bateria cognitiva breve com alta acurácia no diagnóstico de doença de Alzheimer em população com grande heterogeneidade educacional. Arq Neuropsiquiatr 2006;64(supl. 1):200.
¹²
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.
¹³
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd Ed. Washington, D.C.: American Psychiatric Association, 1987.
¹⁴
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
¹⁵
Chaves MLF, Camozzato A, Godinho C, et al. Validity of the Clinical Dementia Rating Scale for the Detection and Staging of Dementia in Brazilian Patients. Alzheimer Dis Assoc Dis 2007;21:210-217.
¹⁶
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX - A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.
¹⁷
Bottino CMC, Almeida OP, Tamai S, Forlenza OV, Scalco MZ, Carvalho IAM. Entrevista estruturada para diagnóstico de transtornos mentais em idosos-CAMDEX The Cambridge examination for mental disorders of the elderly. Versão brasileira, traduzida e adaptada com autorização dos editores, Cambridge University Press, São Paulo, 1999.
¹⁸
Jorm AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry 1988;152:209-213.
¹⁹
Bustamante SE, Bottino CM, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos: resultados preliminares. Arq Neuropsiquiatr 2003;61:601-606.
²⁰
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
²¹
Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatr 2000;15: 1021-1027.
²²
Buschke H, Kuslansky G, Katz M, Stewart WF, et al. Screening for dementia with the Memory Impairment Screen. Neurology 1999;52:231-238.
²³
Kilada S, Gamaldo A, Grant EA, Moghekar A, Morris JC, O'Brien RJ. Brief screening tests for the diagnosis of dementia: comparison with the mini-mental state exam. Alzheimer Dis Assoc Disord 2005;19:8-16.
²⁴
Yassuda MS, Diniz BS, Flaks MK, et al. Neuropsychological profile of Brazilian older adults with heterogeneous educational backgrounds. Arch Clin Neuropsychol 2009;24:71-79.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
20 Sept 2009
Accepted
03 Nov 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Herrera Jr. E, Caramelli P, Silveira AS, Nitrini R. Epidemiological survey of dementia in a community dwelling population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[2] ²
Vasconcelos LG, Brucki SMD, Bueno OFA. Cognitive and functional dementia assessment tools. Dement Neuropsychol 2007;1:18-23.

[3] ³
Folstein MF, Folstein SE, McHugh PR. "Mini-mental State": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[4] ⁴
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[5] ⁵
Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[6] ⁶
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.

[7] ⁷
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico das demências. Arq Neuropsiquiatr 1994;52:457-465.

[8] ⁸
Nitrini R, Caramelli P, Herrera Jr E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.

[9] ⁹
Takada LT, Caramelli P, Charchat HF, et al. Comparison between two tests of delayed recall for the diagnosis of dementia. Arq Neuropsiquiatr 2006;64:35-40.

[10] ¹⁰
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36.

[11] ¹¹
Nitrini R, Caramelli P, Porto CS, et al. Uma bateria cognitiva breve com alta acurácia no diagnóstico de doença de Alzheimer em população com grande heterogeneidade educacional. Arq Neuropsiquiatr 2006;64(supl. 1):200.

[12] ¹²
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.

[13] ¹³
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd Ed. Washington, D.C.: American Psychiatric Association, 1987.

[14] ¹⁴
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[15] ¹⁵
Chaves MLF, Camozzato A, Godinho C, et al. Validity of the Clinical Dementia Rating Scale for the Detection and Staging of Dementia in Brazilian Patients. Alzheimer Dis Assoc Dis 2007;21:210-217.

[16] ¹⁶
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX - A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.

[17] ¹⁷
Bottino CMC, Almeida OP, Tamai S, Forlenza OV, Scalco MZ, Carvalho IAM. Entrevista estruturada para diagnóstico de transtornos mentais em idosos-CAMDEX The Cambridge examination for mental disorders of the elderly. Versão brasileira, traduzida e adaptada com autorização dos editores, Cambridge University Press, São Paulo, 1999.

[18] ¹⁸
Jorm AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry 1988;152:209-213.

[19] ¹⁹
Bustamante SE, Bottino CM, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos: resultados preliminares. Arq Neuropsiquiatr 2003;61:601-606.

[20] ²⁰
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

[21] ²¹
Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatr 2000;15: 1021-1027.

[22] ²²
Buschke H, Kuslansky G, Katz M, Stewart WF, et al. Screening for dementia with the Memory Impairment Screen. Neurology 1999;52:231-238.

[23] ²³
Kilada S, Gamaldo A, Grant EA, Moghekar A, Morris JC, O'Brien RJ. Brief screening tests for the diagnosis of dementia: comparison with the mini-mental state exam. Alzheimer Dis Assoc Disord 2005;19:8-16.

[24] ²⁴
Yassuda MS, Diniz BS, Flaks MK, et al. Neuropsychological profile of Brazilian older adults with heterogeneous educational backgrounds. Arch Clin Neuropsychol 2009;24:71-79.

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