The Brief Cogni-ve Assessment Tool (BCAT): A New Test Emphasizing Contextual Memory and Execu<ve Func<ons

Transcription

1 The Brief Cogni-ve Assessment Tool (BCAT): A New Test Emphasizing Contextual Memory and Execu<ve Func<ons Drs. William Mansbach, Elizabeth MacDougall, & Andrew Rosenzweig November 22, 2011

2 Demen-a Facts Over 65 popula<on projected to double from 36 million in 2003 to 72 million in 2030, and will increase from 12% to 20% of the total popula<on Over 85 popula<on also projected to double from 4.7 million in 2003 to 9.6 million in 2030 Alzheimer s disease (AD) affects over 5 million Americans, with people 85 and older at the highest risk It is es<mated that by 2050, 13 million Americans will have AD Current prevalence rates of demen<a in SNF and ALF is at or above 50% Es<mated cumula<ve costs associated with AD alone will exceed $20 trillion between 2010 and 2050

3 Why a New Cogni-ve Screening Tool? Mini- Mental State Examina<on (MMSE) Short Test of Mental Status (STMS) Montreal Cogni<ve Assessment (MoCA) St. Louis University Mental Status Examina<on (SLUMS) Brief Interview for Mental Status (BIMS)

4 Cogni-ve screening measures can be enhanced if they: can be administered by paraprofessionals and clinicians alike; can be completed in approximately minutes; can differen<ate among MCI, mild demen<a and moderate demen<a; contain a strong, mul<- level verbal memory component; have a broadly complex execu<ve func<on component, and predict IADL performance.

5 BCAT Reliability & Validity Study Study Objec<ves Validate a new cogni<ve test Determine if the BCAT yields sta<s<cally robust Contextual Memory and Execu<ve Func<ons clusters Determine if the BCAT is predic<ve of IADLs

6 BCAT Reliability & Validity Study Method 111 Par<cipants Largely from ALF IRB- approved study Par<cipants referred to Memory Center for comprehensive neuropsychological evalua<on Psychologists expert in demen<a made CDR DX classifica<ons without reference to BCAT scores Demographics: Ages 61-97, 88% Caucasian, 75% widowed, 75% 12/+ educa<on 67% demented, 33% non- demented

7 BCAT Reliability & Validity Study Method, con$nued Select Demographic Characteris$cs and Diagnoses of Par$cipants Characteris<cs Number Percent Gender Male Female Race African- American Caucasian Missing 5 4.8

8 BCAT Reliability & Validity Study Method, con$nued Select Demographic Characteris$cs and Diagnoses of Par$cipants Characteris<cs Number Percent Marital Status Single, Never Married Married Divorced Widowed Missing 1 1.0

9 BCAT Reliability & Validity Study Method, con$nued Select Demographic Characteris$cs and Diagnoses of Par$cipants Characteris<cs Number Percent Educa<on (years completed) > Missing 1 1.0

10 BCAT Reliability & Validity Study Method, con$nued Select Demographic Characteris$cs and Diagnoses of Par$cipants Characteris<cs Number Percent Diagnosis No diagnosis Mild Cogni<ve Impairment Mild Demen<a Moderate Demen<a Severe Demen<a 4 3.8

11 BCAT Reliability & Validity Study Results Average inter- item correla<on for the BCAT was.36 Internal consistency reliability, as es<mated by Cronbach s α based on standardized items, was.92. Test- retest reliability was r =.99. Convergent validity was demonstrated by the significant correla<on of the BCAT with the MMSE, r s =.90, p<.001, and with the STMS, r =.84, p<.001. Discriminant validity was demonstrated by the absence of a rela<onship between the BCAT and the GDS, r s = -.08 (n = 66; median GDS score = 5.0).

12 BCAT Reliability & Validity Study Results, con$nued Addi<onal evidence of construct validity was demonstrated by the significant correla<on of the BCAT with several measures of func<oning and judgment, including the NAB Judgment scale BCAT mean scores were significantly different across the three diagnos<c categories (i.e., MCI, mild demen<a, moderate demen<a), F(2, 94) = 82.03, p<.001, ω 2 =.63 Post- hoc (Bonferroni) analysis revealed significant BCAT mean score differences for MCI vs. mild demen<a, p<.001, MCI vs. moderate demen<a, p<.01, and for mild demen<a vs. moderate demen<a, p<.001

13 BCAT Reliability & Validity Study BCAT Scores by Diagnos$c Category MCI Mild Demen<a Moderate Demen<a Par<cipants n = 31 n = 36 n = 30 BCAT mean score BCAT standard devia<on % confidence interval for BCAT mean

14 BCAT Reliability & Validity Study Results, con$nued The predic<ve validity of the BCAT was addressed with analyses of sensi<vity, specificity, posi<ve predic<ve value, and nega<ve predic<ve value. The area under the ROC curve for the BCAT was.95, p<.001, 95% CI [.91, 1.00]. A BCAT cut- score of 38 yielded maximum sensi<vity, with a PPV of.91, indica<ng a 91% likelihood of correctly diagnosing demen<a. The NPV of.96 indicates a 96% probability of correctly determining that one does not have demen<a.

15 BCAT Reliability & Validity Study Results, con$nued Regression analyses provided further evidence of the predic<ve validity of the BCAT. The BCAT total score was a significant predictor of basic and instrumental ADLs, as measured by the PSMS (ß= -.41, p<.001), and the Lawton IADL scale (ß=.63, p<.001) The 3 clusters were found to be predic<ve of diagnos<c category and the IADL measure

16 BCAT Reliability & Validity Study Predic$ve U$lity of Several BCAT Cut Scores Cut Score a Sensi<vity b Specificity b PPV b NPV b 35/36.91 ( ).84 ( ).93 ( ).81 ( ) 36/37.96 ( ).81 ( ).92 ( ).92 ( ) 37/38.99 ( ).77 ( ).91 ( ).96 ( ) 38/39.99 ( ).61 ( ).85 ( ).95 ( ) 39/40.99 ( ).52 ( ).82 ( ).94 ( ) a BCAT cut- scores to classify par<cipants into demen<a /MCI diagnos<c categories b 95% confidence interval in parentheses

17 BCAT Reliability & Validity Study Principal Component Analysis: 3 Clusters Summary of exploratory principal components analysis results for the BCAT (N = 104) Rotated Factor Loadings Item Story Recogni<on.76 Delayed Story Recall.74 Immediate Story Recall.64 Orienta<on.62 Mental Control #1 Verbal Traits.81 Mental Control #2.63 Judgment.60 Digits Backward.55 Arithme<c Reasoning.55 Immediate Word- List Recall.75 Naming.67 Lever List.61 Language Repe<<on

18 BCAT: The 3 Clusters 1. Contextual Memory Immediate Story Recall Delayed Story Recall Story Recogni<on Orienta<on example Carol borrowed $10 from her brother Jack last week. She couldn t pay him back because she bought a delicious ice cream cone at the circus.

19 BCAT: The 3 Clusters 2. Execu<ve Func<ons Verbal Trails (OTMT) Mental Control (days of the week, backward) Judgment Arithme<c Reasoning Digits Backward example Suppose you have a 1 PM appointment with your doctor. It takes 45 minutes to get there. What <me is the latest you can leave to get there at 1 PM?

20 BCAT: The 3 Clusters 2. Execu<ve Func<ons Verbal Trails (OTMT) Mental Control (days of the week, backward) Judgment Arithme<c Reasoning Digits Backward example You have $25 to spend at the grocery store. You buy milk for $3. You buy 2 apples for a $1. How much money do you have lez?

21 BCAT: The 3 Clusters 3. Aven<onal Capacity Immediate Word List Naming Lever List example Banana Jus<ce Sara Bridge

22 BCAT Reliability & Validity Study Discussion Contextual Memory: u<lity of Story Recall, especially Story Recogni<on Immediate Word List recall: aven<on versus memory Execu<ve Func<ons: u<lity of OTMT (Verbal Trails) Clinical considera<ons: Cut score Cau<on in generalizing Screening results require confirma<on

23 The Brief Cogni-ve Assessment Tool (BCAT) Key Characteris-cs Can be administered by professionals and paraprofessionals 21 items, 50- point scale Can be administered in minutes Has a cut score separa<ng demen<a from Mild Cogni<ve Impairment (MCI) Has scores ranges for MCI, mild demen<a, & moderate demen<a Contains a mul<- level verbal memory component Contains a broadly complex execu<ve func<ons component Predicts Instrumental Ac<vi<es of Daily Living (IADL) The BCAT website has an automated scoring program

24 Introducing the BCAT Website

25 Interpre-ng BCAT Scores Cut score separa<ng demen<a from Mild Cogni<ve Impairment is 37/38 How to interpret the Contextual Memory Cluster How to interpret the Execu<ve Func<ons Cluster How to interpret the Aven<onal Capacity Cluster

26 Published BCAT Research Mansbach, W. E., MacDougall, E. E., & Rosenzweig, A. S. (in press). The Brief Cogni<ve Assessment Tool (BCAT): A new test emphasizing contextual memory, execu<ve func<ons, aven<onal capacity, and the predic<on of instrumental ac<vi<es of daily living. Journal of Clinical and Experimental Neuropsychology.

27 William E. Mansbach, Ph.D. Founder and CEO, Mansbach Health Tools, LLC Chief Opera$ng Officer, MedOp$ons thebcat.com (443)