A new Brief computerized cognitive screening battery (CompCogs) for early diagnosis of Alzheimer's disease

Fichman, Helenice Charchat; Nitrini, Ricardo; Caramelli, Paulo; Sameshima, Koichi

doi:10.1590/S1980-57642009DN20100004

Abstract

Screening tests for early diagnosis of dementia are of great clinical relevance. The ideal test set must be brief and reliable, and should probe cognitive components impaired in Alzheimer's disease (AD). Objectives: To develop a new Computerized Cognitive Screening test (CompCogs), and to investigate its validity for the early diagnosis of AD, and evaluate its heuristic value in understanding the processing of information in AD. Methods: The computerized neuropsychological performance battery, originally including six tests, was applied in forty seven patients with probable mild AD and 97 controls matched for age and education. This computerized neuropsychological test battery, developed with MEL Professional, allows control of timing and order of stimuli presentation, as well as recording of response type and latency. A brief-screening version, CompCogs, was selected using the most discriminative neuropsychological test variables derived from logistic regression analysis. Full battery administration lasted about 40 minutes, while the CompCogs took only 15 minutes. Results: CompCogs included the Face test (correct response) and Word and Forms with Short term memory tests (reaction time). CompCogs presented 91.8% sensitivity and 93.6% specificity for the diagnosis of AD using ROC analyses of AD diagnosis probability derived by logistic regression. Conclusions: CompCogs showed high validity for AD early diagnosis and, therefore, may be a useful alternative screening instrument.

Key words:
Alzheimer's disease; dementia; computerized neuropsychological tests; brief cognitive battery

Resumo

Testes de rastreio para o diagnóstico precoce de demência são de grande relevância clínica. O teste ideal deve ser breve e confiável e inclui componentes cognitivos comprometidos na Doença de Alzheimer (DA). Objetivo: Desenvolver um novo teste computadorizado de rastreio cognitivo (CompCogs), investigar a sua validade para o diagnóstico inicial DA e avaliar o seu valor heurístico na compreensão da velocidade de processamento na DA. Métodos: O desempenho na bateria de testes neuropsicológicos computadorizados, originalmente composta de seis testes, foi avaliado em quarenta e sete pacientes com diagnóstico de DA clinicamente provável em estágio inicial e 97 controles pareados por idade e anos de escolaridade foram estudados. A bateria de testes neuropsicológicos computadorizados, desenvolvida com o programa MEL professional, permite o controle do tempo e ordem de apresentação dos estímulos, bem como, tipo e latência de resposta. A versão breve para rastreio cognitivo, CompCogs, foi selecionada utilizando as variáveis neuropsicológicas com maior poder discrimintativo derivadas da análise de regressão logística. Toda a bateria tem duração de aproximadamente 40 minutos e o CompCogs apenas 15 minutos. Resultados: CompCogs incluiu o teste Face (resposta correta), os testes Palavras e Formas com memória de curto prazo (tempo de reação). O CompCogs apresentou 91,8% de sensibilidade e 93,6% de especificidade baseado na análise da curva ROC da probabilidade do diagnóstico de DA derivada da análise de regressão logística. Conclusões: CompCogs mostrou alta validade para o diagnóstico da DA, portanto é um instrumento alternativo útil para rastreio cognitivo.

Palavras-chave:
doença de Alzheimer; demência; testes neuropsicológicos computadorizados; bateria cognitiva breve

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Acknowledgements

This work was supported by FAPESP grant 97/12238-7.

References

¹
United Nations. Report of the Interregional Seminar to promote the implementation of the International Plan of Action on aging. New York: United Nations Publications and Sales; 1986.
²
Amaducci LA, Lippi A. Descriptive and analytic epidemiology of Alzheimer's disease. In: Maurer K, Riederer P, Beckmann H, editors. Alzheimer's Disease. Epidemiology, Neuropathology, Neurochemistry, and Clinics. Vienna: Springer-Verlag; 1990:41-50.
³
Nitrini R, Mathias SC, Caramelli P. Evaluation of 100 patients with dementia in Sao Paulo, Brazil: correlation with socioeconomic status and education. Alzheimer Dis Assoc Disord 1995;9:146-151.
⁴
Fratiglioni L, Grut M, Forsell Y, et al. Prevalence of Alzheimer disease and other dementias in an elderly urban population: Relationship with age, sex, and education. Neurology 1991;41: 1886-1892.
⁵
Nitrini R, Lefévre BH, Mathias SC, et al. Brief and easy to administer neuropsychological tests in the diagnosis of dementia. Arq Neuropsiquiatr 1994;52:457-465.
⁶
Porto SC, Charchat-Fichman H, Caramelli P, Bahia VA, Nitrini R. Dementia Rating Scale - DRS - in the diagnosis of patients with Alzheimer´s dementia. Arq Neuropsiquiatr 2003; 61:339-345
⁷
Lorentz WJ, Scanlan JM, Borson S. Brief screening tests for dementia. Can J Psychiatry 2002;47:723-733.
⁸
Nitrini R, Caramelli P, Herrera E Jr, 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, Fichman HC, 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. Dem Neuropsychol 2007;1:32-36.
¹¹
Mitrushina M, Uchiyama C, Satz P. Heterogeneity of cognitive profiles in normal aging: implication for early manifestation of Alzheimer's disease. J Clin Exp Neuropsychol 1995;17:374-382.
¹²
Solomon PR, Hirschoff A, Kelly B, et al. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease. Arch Neurol 1998;55:349-355.
¹³
Buschke H, Kuslansky G, Katz M, et al. Screening for dementia with the memory impairment screen. Neurology 1999;52:231-238.
¹⁴
Ritchie K, Leibovici D, Ledésert B, Touchon J. A typology of sub-clinical senescent cognitive disorder. Br J Psychiatry 1996; 168:470-476.
¹⁵
Ritchie K, Ledésert B, Touchon J. Subclinical cognitive impairment: Epidemiology and clinical characteristics. Compr Psychiat 2000;41(suppl):61-65.
¹⁶
Robbins TW, James M, Owen AM, Sahakian BJ, McInnes L, Rabbitt P. Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 1994;5:266-281.
¹⁷
Robbins TW, James M, Owen AM, et al. A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: implications for theories of executive functioning and cognitive aging. J Int Neuropsychol Soc 1998;4:474-490.
¹⁸
Veroff AE, Cutler N, Sramek J, Prior P, Mickelson W, Hartman J. A new assessment tool for neuropsychopharmacologic research: the Computerized Neuropsychological Test Battery. J Geriatr Psychiatry Neurol 1991;4:211-217.
¹⁹
Veroff AE, Bodick NC, Offen WW, Sramek JJ, Cutler NR. Efficacy of xanomeline in Alzheimer disease: Cognitive improvement measured using the Computerized Neuropsychological Test Battery (CNTB). Alzheimer Dis Assoc Dis 1998;12:304-312.
²⁰
Charchat H; Nitrini R., Caramelli P, Sameshima K. Investigação de marcadores clínicos dos estágios iniciais da doença de Alzheimer com testes neuropsicológicos computadorizados. Rev Psicol: Refl Crít 2001;14:305-316.
²¹
Charchat H. Desenvolvimento de uma bateria de testes neuropsicológicos computadorizados para o diagnóstico precoce da Doença de Alzheimer. Dissertação, Instituto de Psicologia, Universidade de São Paulo, SP.
²²
Karczyn AD, Aharonson, V. Computerized methods in the assessment and prediction of dementia. Curr Alzheimer Res 2007;4:364-369.
²³
Doniger GM, Dowolatsky T, Zucher DM, Chertkow H, Schweiger A, Simon ES. Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms Am J Alzheimers Dis Other Dem 2006;21:28-36.
²⁴
Doniger GM, Zucker DM, Schweiger A, et. al. Towards practical cognitive assessment for detection of early dementia: a 30 minute computerized battery discriminates as well as longer testing. Curr Alzheimer Res 2005;2:117-124.
²⁵
Caramelli P, Chaves ML, Engelhard E, et al. Effects of galantamine on attention and memory in Alzheimer´s disease measured by computerized neuropsychological tests: results of the Brazilian Multi-Center Galantamine study (GAL-BRA-01) Arq Neurpsiquiatr 2004;62:379-384.
²⁶
Meulen EF, Schmand B, van Campen JP, et al. The seven minute screen: a neurocognitive screening test highly sensitive to various types of dementia. J Neurol Neurosurg Psychiatry 2004;75:700-705.
²⁷
Kay GG, Starbuck VN. Computerized neuropsychological assessment. In: Maruish ME, Moses Jr JM, editors. Clinical Neuropsychology: Theoretical Foundations for Practitioners. Mahwah: Lawrence Erlbaum Associates;1997:143-161.
²⁸
Mead AD, Drasgow F. Equivalence of computerized and paper-and-pencil cognitive ability tests: a meta-analysis. Psych Bull 1993;114:449-458.
²⁹
Butcher JN, Perry JN, Atlis MM. Validity and utility of computer-based test interpretation. Psychol Assess 2000;12:6-18.
³⁰
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.
³¹
Hudges CP, Berg L, Danzinger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
³²
Schneider W. MEL Professional User's Guide. Pittsburgh: Psychology Software Tools Inc; 1995.
³³
Mitrushina M, Satz P, Drebing C, et al. The differential pattern of memory deficit in normal aging and dementias of different etiology. J Clin Psychol 1994;50:246-252.
³⁴
Kerr B, Calogero M, Vitiello MV, Prinz PN, Williams DE, Wilkie F. Letter matching: Effects of age, Alzheimer's disease, and major depression. J Clin Exp Neuropsychol 1992;14:478-498.
³⁵
Nebes RD, Brady CB. Generalized cognitive slowing and severity of dementia in Alzheimer's disease: implications for the interpretation of response-time data. J Clin Exp Neuropsychol 1992;14:317-326.
³⁶
Hofman M, Seifritz E, Kräuchi K, et al. Alzheimer's disease, depression and normal ageing: Merit of simple psychomotor and visuospatial tasks. Int J Geriatr Psychiatry 2000;15: 31-39.
³⁷
Baddeley AD, Hitch GJ. Working memory. In: Bower G, editor. Recent Advances in Learning and Motivation. Londres: Academic Press; 1974:47-90.
³⁸
Morris RG, Baddeley AD. Primary and working memory functioning in Alzheimer-type dementia. J Clin Exp Neuropsychol 1988;10:279-296.
³⁹
Baddeley AD, Logie R, Bressi S, Della Sala S, Spinnler H. Dementia and working memory. Q J Exp Psychol Sect A-Hum Exp Psychol 1986;38:603-618.
⁴⁰
Baddeley AD, Bressi S, Della Sala S, Logie R, Spinnler H. The decline of working memory in Alzheimer's disease: A longitudinal study. Brain 1991;114:2521-2542.
⁴¹
Caramelli P, Poissant A, Gauthier S, et al. Educational level and neuropsychological heterogeneity in dementia of the Alzheimer type. Alzheimer Dis Assoc Dis 1997;11:9-15.

Publication Dates

Publication in this collection
Jan-Mar 2008

History

Received
21 Jan 2008
Reviewed
20 Feb 2008
Accepted
20 Feb 2008

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

[1] ¹
United Nations. Report of the Interregional Seminar to promote the implementation of the International Plan of Action on aging. New York: United Nations Publications and Sales; 1986.

[2] ²
Amaducci LA, Lippi A. Descriptive and analytic epidemiology of Alzheimer's disease. In: Maurer K, Riederer P, Beckmann H, editors. Alzheimer's Disease. Epidemiology, Neuropathology, Neurochemistry, and Clinics. Vienna: Springer-Verlag; 1990:41-50.

[3] ³
Nitrini R, Mathias SC, Caramelli P. Evaluation of 100 patients with dementia in Sao Paulo, Brazil: correlation with socioeconomic status and education. Alzheimer Dis Assoc Disord 1995;9:146-151.

[4] ⁴
Fratiglioni L, Grut M, Forsell Y, et al. Prevalence of Alzheimer disease and other dementias in an elderly urban population: Relationship with age, sex, and education. Neurology 1991;41: 1886-1892.

[5] ⁵
Nitrini R, Lefévre BH, Mathias SC, et al. Brief and easy to administer neuropsychological tests in the diagnosis of dementia. Arq Neuropsiquiatr 1994;52:457-465.

[6] ⁶
Porto SC, Charchat-Fichman H, Caramelli P, Bahia VA, Nitrini R. Dementia Rating Scale - DRS - in the diagnosis of patients with Alzheimer´s dementia. Arq Neuropsiquiatr 2003; 61:339-345

[7] ⁷
Lorentz WJ, Scanlan JM, Borson S. Brief screening tests for dementia. Can J Psychiatry 2002;47:723-733.

[8] ⁸
Nitrini R, Caramelli P, Herrera E Jr, 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, Fichman HC, 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. Dem Neuropsychol 2007;1:32-36.

[11] ¹¹
Mitrushina M, Uchiyama C, Satz P. Heterogeneity of cognitive profiles in normal aging: implication for early manifestation of Alzheimer's disease. J Clin Exp Neuropsychol 1995;17:374-382.

[12] ¹²
Solomon PR, Hirschoff A, Kelly B, et al. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease. Arch Neurol 1998;55:349-355.

[13] ¹³
Buschke H, Kuslansky G, Katz M, et al. Screening for dementia with the memory impairment screen. Neurology 1999;52:231-238.

[14] ¹⁴
Ritchie K, Leibovici D, Ledésert B, Touchon J. A typology of sub-clinical senescent cognitive disorder. Br J Psychiatry 1996; 168:470-476.

[15] ¹⁵
Ritchie K, Ledésert B, Touchon J. Subclinical cognitive impairment: Epidemiology and clinical characteristics. Compr Psychiat 2000;41(suppl):61-65.

[16] ¹⁶
Robbins TW, James M, Owen AM, Sahakian BJ, McInnes L, Rabbitt P. Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 1994;5:266-281.

[17] ¹⁷
Robbins TW, James M, Owen AM, et al. A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: implications for theories of executive functioning and cognitive aging. J Int Neuropsychol Soc 1998;4:474-490.

[18] ¹⁸
Veroff AE, Cutler N, Sramek J, Prior P, Mickelson W, Hartman J. A new assessment tool for neuropsychopharmacologic research: the Computerized Neuropsychological Test Battery. J Geriatr Psychiatry Neurol 1991;4:211-217.

[19] ¹⁹
Veroff AE, Bodick NC, Offen WW, Sramek JJ, Cutler NR. Efficacy of xanomeline in Alzheimer disease: Cognitive improvement measured using the Computerized Neuropsychological Test Battery (CNTB). Alzheimer Dis Assoc Dis 1998;12:304-312.

[20] ²⁰
Charchat H; Nitrini R., Caramelli P, Sameshima K. Investigação de marcadores clínicos dos estágios iniciais da doença de Alzheimer com testes neuropsicológicos computadorizados. Rev Psicol: Refl Crít 2001;14:305-316.

[21] ²¹
Charchat H. Desenvolvimento de uma bateria de testes neuropsicológicos computadorizados para o diagnóstico precoce da Doença de Alzheimer. Dissertação, Instituto de Psicologia, Universidade de São Paulo, SP.

[22] ²²
Karczyn AD, Aharonson, V. Computerized methods in the assessment and prediction of dementia. Curr Alzheimer Res 2007;4:364-369.

[23] ²³
Doniger GM, Dowolatsky T, Zucher DM, Chertkow H, Schweiger A, Simon ES. Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms Am J Alzheimers Dis Other Dem 2006;21:28-36.

[24] ²⁴
Doniger GM, Zucker DM, Schweiger A, et. al. Towards practical cognitive assessment for detection of early dementia: a 30 minute computerized battery discriminates as well as longer testing. Curr Alzheimer Res 2005;2:117-124.

[25] ²⁵
Caramelli P, Chaves ML, Engelhard E, et al. Effects of galantamine on attention and memory in Alzheimer´s disease measured by computerized neuropsychological tests: results of the Brazilian Multi-Center Galantamine study (GAL-BRA-01) Arq Neurpsiquiatr 2004;62:379-384.

[26] ²⁶
Meulen EF, Schmand B, van Campen JP, et al. The seven minute screen: a neurocognitive screening test highly sensitive to various types of dementia. J Neurol Neurosurg Psychiatry 2004;75:700-705.

[27] ²⁷
Kay GG, Starbuck VN. Computerized neuropsychological assessment. In: Maruish ME, Moses Jr JM, editors. Clinical Neuropsychology: Theoretical Foundations for Practitioners. Mahwah: Lawrence Erlbaum Associates;1997:143-161.

[28] ²⁸
Mead AD, Drasgow F. Equivalence of computerized and paper-and-pencil cognitive ability tests: a meta-analysis. Psych Bull 1993;114:449-458.

[29] ²⁹
Butcher JN, Perry JN, Atlis MM. Validity and utility of computer-based test interpretation. Psychol Assess 2000;12:6-18.

[30] ³⁰
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.

[31] ³¹
Hudges CP, Berg L, Danzinger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[32] ³²
Schneider W. MEL Professional User's Guide. Pittsburgh: Psychology Software Tools Inc; 1995.

[33] ³³
Mitrushina M, Satz P, Drebing C, et al. The differential pattern of memory deficit in normal aging and dementias of different etiology. J Clin Psychol 1994;50:246-252.

[34] ³⁴
Kerr B, Calogero M, Vitiello MV, Prinz PN, Williams DE, Wilkie F. Letter matching: Effects of age, Alzheimer's disease, and major depression. J Clin Exp Neuropsychol 1992;14:478-498.

[35] ³⁵
Nebes RD, Brady CB. Generalized cognitive slowing and severity of dementia in Alzheimer's disease: implications for the interpretation of response-time data. J Clin Exp Neuropsychol 1992;14:317-326.

[36] ³⁶
Hofman M, Seifritz E, Kräuchi K, et al. Alzheimer's disease, depression and normal ageing: Merit of simple psychomotor and visuospatial tasks. Int J Geriatr Psychiatry 2000;15: 31-39.

[37] ³⁷
Baddeley AD, Hitch GJ. Working memory. In: Bower G, editor. Recent Advances in Learning and Motivation. Londres: Academic Press; 1974:47-90.

[38] ³⁸
Morris RG, Baddeley AD. Primary and working memory functioning in Alzheimer-type dementia. J Clin Exp Neuropsychol 1988;10:279-296.

[39] ³⁹
Baddeley AD, Logie R, Bressi S, Della Sala S, Spinnler H. Dementia and working memory. Q J Exp Psychol Sect A-Hum Exp Psychol 1986;38:603-618.

[40] ⁴⁰
Baddeley AD, Bressi S, Della Sala S, Logie R, Spinnler H. The decline of working memory in Alzheimer's disease: A longitudinal study. Brain 1991;114:2521-2542.

[41] ⁴¹
Caramelli P, Poissant A, Gauthier S, et al. Educational level and neuropsychological heterogeneity in dementia of the Alzheimer type. Alzheimer Dis Assoc Dis 1997;11:9-15.

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