Work

P4‐124: Development and Validation of a Brief Cognitive Screening Instrument: The Sweet 16

Year: 2010

Type: article

Abstract: Cognitive impairment contributes to loss of independence, decreased quality of life, and increased health care costs among older adults, but is often unrecognized. Current screening instruments are underutilized, may lack sensitivity in particular groups, and may be restricted by copyright laws. To develop and validate the Sweet 16, a new open-access screening instrument for cognitive impairment. The Sweet 16 was developed in a cohort of 918 participants from the Yale Delirium Prevention Trial. Performance of the Sweet 16 was compared against the Mini-Mental State Examination (MMSE) and modified Blessed Dementia Rating Scale (mBDRS). Equipercentile equating was used to identify cutpoints correlating with clinically acceptable cutpoints of the MMSE. Performance characteristics of the Sweet 16 were also validated in a separate cohort of 709 participants from the Aging, Demographics, and Memory Study by comparison against the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as an independent reference standard for cognitive impairment. The instrument can be administered in 3 minutes or less with minimal training. In the development cohort, the Sweet 16 was highly correlated with the MMSE (Spearman's rho=0.80, P<.001) and the mBDRS (Spearman's rho=-0.38, P<.001). When validated against the IQCODE, the area under the curve (AUC) was 0.84 for the Sweet 16, and 0.81 for the MMSE (P=0.06). A Sweet 16 score <14 (approximately equivalent to MMSE <24) with a sensitivity of 81% and specificity of 76%, performed better than the MMSE, which had a sensitivity of 64% and specificity of 86%. Analysis by education demonstrated that for higher education (≥12 years) the AUC for the Sweet 16 was 0.89 and for the MMSE 0.84 (p = 0.03). The sensitivity of the Sweet 16 score <14 was superior to the MMSE across every quartile of education. We have developed and validated a brief cognitive screening instrument that is quick, easy to administer, and will be open-access. We have identified cutpoints on the Sweet 16 that are consistent with those widely used for the MMSE, and the performance characteristics of the Sweet 16 are superior to the MMSE across all levels of education.

Source: Alzheimer s & Dementia

DOI: 10.1016/j.jalz.2010.08.183