Cognitive Abilities Screening Instrument, Chinese Version 2.0 (CASI C-2.0): Administration and Clinical Application

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1 Continuing Medical Education 180 Cognitive Abilities Screening Instrument, Chinese Version 2.0 (CASI C-2.0): Administration and Clinical Application Ker-Neng Lin 1,2, Pei-Ning Wang 1,3, Hsiu-Chih Liu 1,3, Evelyn L. Teng 4 Abstract- The Cognitive Abilities Screening Instrument (CASI) has been commonly used in dementia research and clinical practice to evaluate a subject s cognitive abilities and to follow-up possible progression of dementia. It has a detailed manual for test administration and scoring in order to minimize testing errors. The Chinese version of CASI (CASI C-2.0) has been used in many clinical and epidemiological studies in Taiwan. Since cognitive abilities are influenced by education, and there are high rates of illiterate or loweducation individuals among the elderly in Taiwan, the normative data of CASI, including its total score and its cognitive domain scores, should be divided into different education ranges. In clinical practice, the cut-off scores in differentiating between dementia and normal are suggested to be: 49/50 for Education year = 0; 67/68 for Education years = 1-5; and 79/80 for Education years 6. Key Words: CASI, dementia, cognitive function, norm, cutoff score From the 1 Department of Neurology, Taipei Veterans General Hospital, 2 Department of Psychology, Soochow University, 3 Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC, and 4 Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA Received August 8, Revised October 4, Accepted November 9, Correspondence to: Ker-Neng Lin, Ph.D. Department of Neurology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11216, Taiwan (R.O.C.) knlin@vghtpe.gov.tw

2 181 1,2, 1,3, 1,3, 4 (Cognitive Abilities Screening Instrument (CASI)) CASI (CASI C-2.0) CASI CASI ( 0 ) 49/50 ( 1-5 ) 67/68 ( 6 ) 79/80 Acta Neurol Taiwan 2012;21: (Cognitive Abilities Screening Instrument (CASI)) (1-8) (2) (Mini-Mental State Examination (MMSE)) (1,9-11) ( ) 5 10 MMSE (02) (02) knlin@vghtpe.gov.tw

3 182 MMSE MMSE Cognitive Abilities Screening Instrument (CASI) CASI CASI 1990 The Hasegawa Dementia Screening Scale (HDSS) HDSS (HDS-R) The Mini- Mental State Examination (MMSE) The Modified Mini-Mental Scale (3MS) Test CASI (cognitive domains) MMSE CASI (Attention; ATTEN) (Mental manipulation; MENMA) (Shortterm memory; STM) (Long-term memory; LTM) (Orientation; ORIEN) (Language; LANG) (Drawing; DRAW) (Abstract thinking and judgment; ABSTR) (Animal-name fluency; ANML) (cognitive domain) ( ) MMSE (STM MMSE 3 vs. CASI 12 ORIEN MMSE 10 vs. CASI 18 ) CASI (LTM) (10) (STM) (12) (ATTEN) (8) (MENMA) (10) (ORIEN) (18) (ABSTR) (12) (LANG) (10) (DRAW) (10) (ANML) (10) (12-14) CASI CASI CASI CASI 1. CASI CASI 2. CASI

4 CASI ( ) 4. CASI 5. CASI ( ) ( 4 ) ( 7 18 ) MMSE (free recall) CASI ( 3 ) ( 2 ) ( 1 ) CASI ( 7 18 ) 7 ( ) ( ) ( ) CASI CASI

5 ( ) ( 2 ) ( 4 ) CASI CASI (VLDT) 1 (VLDT1, VLDT2) VLDT1 VLDT2 9 VLDT (2 3 ) VLDT1 VLDT2 CASI 11. CASI CASI CASI CASI CASI MMSE CASI 6 CASI (cutoff score) (1) 77/78 ( N=112 =0.91 =0.91) (2) 85/86 ( N=157 =0.94 =0.94) (3) 75/76 ( N=84 =0.95 =0.94) (4) 75/76 ( N=90 =0.93 =0.93) (5) Graves 85/86 (N= =0.97 =0.92) (15) CASI (16,17) CASI 1990 CASI 65

6 185 50/51 ( =0.88 =0.94) (3) (86/87 81/82) 76% CASI 709 ( ) 67 (CDR=0) 149 (CDR=0.5) 493 (CDR 1) CDR=1 226 CDR=2 169 CDR=3 98 CASI 709 CASI (n=67) (n=149) (n=493) / 40 / / / 228 ( ) ( ) CDR* CASI #, & (100) LTM # (10) STM # (12) ATTEN # (8) MENMA # (10) ORIEN # (18) ABSTR # (12) LANG # (10) DRAW # (10) ANML # (10) * CDR (Clinical Dementia Rating) # CASI ( ) (LTM) (STM) (ATTEN) (MENMA) (ORIEN) (ABSTR) (LANG) (DRAW) (ANML) & CASI t-test: p<0.01 ( , No.7: p73~88) (18) CASI (t-test, p<0.05) CASI ( 1) ( 2) CASI (12) 475 CASI CASI Z CASI (Att) (Conc) (Ori) (STM) (LTM) (Lang) (VC) (Flu) (A-J) ( 12. Liu, et al., 2002 p. 247, Fig 1. Permission from S. Karger AG)

7 CASI (n=238) (n=238) (n=155) (n=155) (n=82) (n=82) / (%) 51.7 / / / / / / 51.2 ( ) ( ) CASI # ATTEN (8) MENMA (10) ORIEN (18) STM (12) LTM (10) LANG (10) DRAW (10) ANML (10) ABSTR (12) # (ATTEN) (MENMA) (ORIEN) (STM) (LTM) (LANG) (DRAW) (ANML) (ABSTR) (STM) STM STM (Ori) (STM) Ori STM ( 2~3 Z ) (LTM) CASI (19) 2314 CASI CDR (NINCDS-ADRDA) ( ) ( =76.1 =6.3) 0-25 ( =5.2 =5.7) CASI C-2.0 (20) CASI C-2.0 (Dementia) (Non-dementia) (p<0.01) (Edu=0 ) ( )

8 187 CASI C-2.0 Group CASI score # Cutoff Sensi. Speci. Dementia ( N ) Non-Dementia ( N ) Edu= (166) (677) 49/ Male ( 29) (183) 56/ Female (137) (494) 49/ Age (102) (437) 51/ Age ( 64) (240) 46/ Edu= ( 97) (233) 67/ Age ( 69) (173) 67/ Age ( 28) ( 60) 58/ Edu (655) (268) 79/ Age (491) (225) 79/ Age (164) ( 43) 81/ # : CASI (p<0.01) Edu: Education years; Sensi.: Sensitivity; Speci.: Specificity. ( 20. Lin et al., Dement Geriatr Cogn Disord 2002; 14: p.180, Table 4. Permission from S. Karger AG) 1178 CASI C-2.0 P10 P20 P5 P50 Edu = 0 Edu = 1-5 Edu 6 Age Age Age P5: 5 th percentile; P10: 10 th percentile; P20: 20 th percentile; P50: 50 th percentile; Edu: Education years ( CASI ) CASI ( 0 ) 49/50 ( 1-5 ) 67/68 ( 6 ) 79/80 (1,20) 1178 (Age 69 Age Age 80 ) (Education year = 0 Education years = 1-5 Education years 6 ) CASI (percentile) (P5, P10, P20, P50) CASI

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