RESUMO
OBJECTIVE: This study examined the impact of impairment in two specific cognitive abilities, processing speed and memory, on Dot Counting Test (DCT) classification accuracy by evaluating performance validity classification accuracy across cognitively unimpaired, single-domain impairment, and multidomain impairment subgroups within a mixed clinical sample. METHOD: Cross-sectional data were analyzed from 348 adult outpatients classified as valid (n = 284) or invalid (n = 64) based on four independent criterion performance validity tests (PVTs). Unimpaired (n = 164), single-domain processing speed impairment (n = 24), single-domain memory impairment (n = 53), and multidomain processing speed and memory impairment (n = 43) clinical subgroups were established among the valid group. Both the traditional DCT E-score and unrounded E-score were examined. RESULTS: Overall, the DCT demonstrated acceptable to excellent classification accuracy across the unimpaired (area under the curve [AUC] traditional E-score=.855; unrounded E-score=.855) and single-domain impairment groups (traditional E-score AUCs = .690-.754; unrounded E-score AUCs = .692-747). However, it did not reliably discriminate the multidomain processing speed and memory impairment group from the invalid performers (traditional and unrounded E-scores AUC = .557). CONCLUSIONS: Findings support the DCT as a non-memory-based freestanding PVT for use with single-domain cognitive impairment, with traditional E-score ≥17 (unrounded E-score ≥16.95) recommended for those with memory impairment and traditional E-score ≥19 (unrounded ≥18.08) with processing speed impairment. Moreover, results replicated previously established optimal cutoffs for unimpaired groups using both the traditional (≥14) and unrounded (≥13.84) E-scores. However, the DCT did not reliably discriminate between invalid performance and multidomain cognitive impairment, indicating caution is warranted when using the DCT with patients suspected of greater cognitive impairment.
RESUMO
BACKGROUND: The incidence rate of breast cancer is rising rapidly in Hong Kong. Lymphedema is a serious long-term complication of breast cancer surgery and radiation therapy. OBJECTIVE: The objectives of this study were to evaluate risk factors associated with the development of lymphedema for patients with breast cancer who have had an axillary lymph node dissection and to explore potential factors associated with moderate to severe lymphedema. METHODS: This was a matched case-control study of 202 women undergoing a unilateral axillary dissection for breast cancer, consisting of 101 cases with lymphedema and 101 controls who matched cases in terms of surgery date, axillary radiotherapy, and cancer stage. Arm circumferences were measured to determine presence and severity of lymphedema. Potential risk factors were collected by using clinical data and a questionnaire. A multiple logistic regression was used to obtain the adjusted odds ratios for potential risk factors for developing lymphedema. Exploratory analysis was also performed to identify factors associated with the development of moderate to severe lymphedema. RESULTS: Adjusted odds ratios for the development of lymphedema were 3.80 (95% confidence interval [CI] = 1.84-7.87) for previous inflammation-infection and 1.06 (95% CI = 1.02-1.10) for an increase of 1 year of age at axillary dissection. On exploratory analysis, adjusted odds ratios for moderate to severe degree of lymphedema were 4.53 (95% CI = 2.16-9.52) for previous inflammation-infection, 2.94 (95% CI = 1.44-6.03) for operation on dominant arm, 1.11 (95% CI = 1.01-1.22) for an increase of 1 kg/m in body mass index (BMI) at recruitment, and 1.05 (95% CI = 1.01-1.10) for an increase of 1 year of age at recruitment time. DISCUSSION: Previous inflammation-infection and advanced age at axillary dissection are risk factors associated with the initiation of lymphedema. Previous inflammation-infection, operation on the side of the dominant hand, obesity, and aging are potential risk factors associated with the aggravation of lymphedema. Greater BMI is still a risk factor for lymphedema progression even in a lower BMI population.
