Brief version of the CAMCOG for illiterate older adults with Alzheimer's dementia / Versão breve do CAMCOG para idosos analfabetos com doença de Alzheimer

Abstract Background: The Cambridge Cognition Examination (CAMCOG) is one of the most used cognitive assessment batteries for older adults. Objective: To evaluate a brief version of the CAMCOG for illiterate older adults (CAMCOG-BILL) with Alzheimer's dementia (AD) and healthy controls (CG). Methods: Cross-sectional case-control study with 246 illiterate older adults (AD [n=159] and CG [n=87], composed by healthy seniors without cognitive complaints) who never attended school or took reading or writing lessons. Diagnosis of AD was established based on the NIA-AA and DSM-5 criteria. All participants were assessed with the CAMCOG by a researcher blinded for diagnosis. To assess the consistency of the chosen CAMCOG-BILL sub-items, we performed a binary logistic regression analysis. Results: Both the CAMCOG and the CAMCOG-BILL had satisfactory psychometric properties. The area under the curve (AUC) was 0.932 (p<0.001) for the original version of CAMCOG and 0.936 for the CAMCOG-BILL. Using a cut-off score of ≥60 (CAMCOG) and ≥44 (CAMCOG-BILL), both instruments had the same sensitivity and specificity (89 and 96%, respectively). Conclusion: The CAMCOG-BILL may be a preferred tool because of the reduced test burden for this vulnerable subgroup of illiterate patients with dementia.

RESUMO Antecedentes: O Cambridge Cognition Examination (CAMCOG) é uma das baterias de avaliação cognitiva mais usadas para idosos. Objetivos: Avaliar uma versão breve do CAMCOG para idosos analfabetos (CAMCOG-BILL) com demência de Alzheimer (DA) em comparação com controles saudáveis não demenciados (GC). Métodos: Estudo caso-controle transversal com 246 idosos analfabetos (AD [n=159] e GC [n=87], composto por idosos saudáveis sem queixas cognitivas) que nunca frequentaram a escola ou fizeram aulas de leitura ou redação. O diagnóstico de DA foi estabelecido pelos critérios NIA-AA e DSM-5. Todos os participantes foram avaliados por meio do CAMCOG por avaliador cego, para o diagnóstico dos grupos. Para avaliar a consistência dos subitens escolhidos do CAMCOG-BILL, realizou-se uma análise de regressão logística binária. Resultados: Tanto o CAMCOG quanto o CAMCOG-BILL apresentaram propriedades psicométricas satisfatórias. A área sob a curva (AUC) foi de 0,932 (p<0,001) para a versão original do CAMCOG e de 0,936 para o CAMCOG-BILL. Usando-se uma pontuação de corte de ≥60 (CAMCOG) e ≥44 (CAMCOG-BILL), ambos os instrumentos tiveram a mesma sensibilidade e especificidade (89 e 96%, respectivamente). Conclusão: O CAMCOG-BILL pode ser preferido para reduzir a sobrecarga do teste para esse subgrupo vulnerável de pacientes analfabetos com demência.

Psychometric properties of Cognitive Instruments in Vascular Dementia and Alzheimer's disease: a neuropsychological study

OBJECTIVES: To describe elderly performance in the Bender Gestalt Test (BGT) and to discriminate its score by using types of errors as comparison among healthy controls, Alzheimer's disease (AD) patients, and vascular dementia (VD) patients. METHODS: We performed a cross-sectional analysis of 285 elderly individuals of both sexes, all over 60 years old and with more than 1 year of schooling. All participants were assessed through a detailed clinical history, laboratorial tests, neuroimaging, and neuropsychological tests including the BGT, the Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Pfeffer Functional Activities Questionnaire (PFAQ). The BGT scores were not used to establish diagnosis. RESULTS: Mean BGT scores were 3.2 for healthy controls, 7.21 for AD, and 8.04 for VD with statistically significant differences observed between groups (p<0.0001). Logistic regression analysis was used to identify the main risk factors for the diagnostic groups. BGT's scores significantly differentiated the healthy elderly from those with AD (p<0.0001) and VD (p<0.0001), with a higher area under the curve, respectively 0.958 and 0.982. BGT's scores also showed that the AD group presented 12 types of errors. Types of errors evidenced in the execution of this test may be fundamental in clinical practice because it can offer differential diagnoses between senescence and senility. CONCLUSION: A cut-off point of 4 in the BGT indicated cognitive impairment. BGT thus provides satisfactory and useful psychometric data to investigate elderly individuals.