Adaptive measurement of cognitive function based on multidimensional item response theory

IF 4.9 Q1 CLINICAL NEUROLOGY

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Pub Date : 2024-11-30 DOI:10.1002/trc2.70018

Robert D. Gibbons, Diane S. Lauderdale, Robert S. Wilson, David A. Bennett, Tesnim Arar, David A. Gallo

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Abstract

INTRODUCTION

Up to 20% of older adults in the United States have mild cognitive impairment (MCI), and about one-third of people with MCI are predicted to transition to Alzheimer's disease (AD) within 5 years. Standard cognitive assessments are long and require a trained technician to administer. We developed the first computerized adaptive test (CAT) based on multidimensional item response theory (MIRT) to more precisely, rapidly, and repeatedly assesses cognitive abilities across the adult lifespan. We present results for a prototype CAT (pCAT-COG) for assessment of global cognitive function.

METHODS

We sampled items across five cognitive domains central to neuropsychological testing (episodic memory [EM], semantic memory/language [SM], working memory [WM], executive function/flexible thinking, and processing speed [PS]). The item bank consists of 54 items, with 9 items of varying difficulty drawn from six different cognitive tasks. Each of the 54 items has 3 response trials, yielding an ordinal score (0–3 trials correct). We also include three long-term memory items not designed for adaptive administration, for a total bank of 57 items. Calibration data were collected in-person and online, calibrated using a bifactor MIRT model, and pCAT-COG scores validated against a technician-administered neuropsychological battery.

RESULTS

The bifactor MIRT model improved fit over a unidimensional IRT model (p < 0.0001). The global pCAT-COG scores were inversely correlated with age (r = –0.44, p < 0.0001). Simulated adaptive administration of 11 items maintained a correlation of r = 0.94 with the total item bank scores. Significant differences between mild and no cognitive impairment (NCI) were found (effect size of 1.08 SD units). The pCAT-COG correlated with clinician-based global measure (r = 0.64).

DISCUSSION

MIRT-based CAT is feasible and valid for the assessment of global cognitive impairment, laying the foundation for the development of a full CAT-COG that will draw from a much larger item bank with both global and domain specific measures of cognitive impairment.

Highlights

As Americans age, numbers at risk for developing cognitive impairment are increasing.
Aging-related declines in cognition begins decades prior to the onset of obvious cognitive impairment.
Traditional assessment is burdensome and requires trained clinicians.
We developed an adaptive testing framework using multidimensional item response theory.
It is comparable to lengthier in-person assessments that require trained psychometrists.

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来源期刊

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Medicine-Psychiatry and Mental Health

CiteScore

10.10

自引率

2.10%

发文量

134

审稿时长

10 weeks

期刊介绍： Alzheimer''s & Dementia: Translational Research & Clinical Interventions (TRCI) is a peer-reviewed, open access,journal from the Alzheimer''s Association®. The journal seeks to bridge the full scope of explorations between basic research on drug discovery and clinical studies, validating putative therapies for aging-related chronic brain conditions that affect cognition, motor functions, and other behavioral or clinical symptoms associated with all forms dementia and Alzheimer''s disease. The journal will publish findings from diverse domains of research and disciplines to accelerate the conversion of abstract facts into practical knowledge: specifically, to translate what is learned at the bench into bedside applications. The journal seeks to publish articles that go beyond a singular emphasis on either basic drug discovery research or clinical research. Rather, an important theme of articles will be the linkages between and among the various discrete steps in the complex continuum of therapy development. For rapid communication among a multidisciplinary research audience involving the range of therapeutic interventions, TRCI will consider only original contributions that include feature length research articles, systematic reviews, meta-analyses, brief reports, narrative reviews, commentaries, letters, perspectives, and research news that would advance wide range of interventions to ameliorate symptoms or alter the progression of chronic neurocognitive disorders such as dementia and Alzheimer''s disease. The journal will publish on topics related to medicine, geriatrics, neuroscience, neurophysiology, neurology, psychiatry, clinical psychology, bioinformatics, pharmaco-genetics, regulatory issues, health economics, pharmacoeconomics, and public health policy as these apply to preclinical and clinical research on therapeutics.