Neuropsychology Metrics Flashcards
What are the advantages of using a test such as the MMSE to screen cognitive abilities?
Disadvantages?
- Advantages
- brief, objective, quantitative
- some info patient’s general abilities
- Disadvantages
- false-positive results from older people or with < 9 yr education
- low “ceilling” so those who perform well are not necessarily cognitively intact
- research suggests not a thorough cognitive assessment
What was the intended use of the MMS?
- differentiate “organic” vs functional psychatric patient
- to screen for cognitive impairment/dementia
- monitor for change over time
What is the range of scoring for the MMSE?
What is normal for relative education level?
- Range
- 24-30: no cognitive impairment
- 18-23: mild cognitive impairment
- 0-17: severe cognitie impairment
- Education
- <8th grade: <21 is abnormal
- <12th grade: <24 is abnormal
- college: <25 is abnormal
What are the ranges of scores for the MoCA?
- 30 max
- 18-26: mild cognitive impairment
- 10-17: moderate cognitie impairment
- <10 severe cognitive impairment
+1 point for education <12 yrs
What cognitive tasts are assessed in MoCA but not in MMSE? (5)
- executive function
- attention
- fluency tasks - two item & phonemic
- verbal abstraction - two item
What cognitive tasts are assessed in both MoCA and MMSE? (6)
- visuospatial
- language
- concentration
- working memory
- memory recall
- orientation
What assessment component is seen in SLUMS and not in MMSE or MoCA?
short story
(may add additionaly memory assessment)
What are the ranges of scores for the SLUMS?
- >12 yr education
- 27-30: normal
- 21-16: mild cognitive impairment
- 1-20: dementia
- <12 years school
- 25-30: normal
- 20-24: mild cognitive impairment
- 1-19: dementia
What content is assessed both by MoCA and SLUMS?
- orientation/time
- registration/recall
- praxis / visuospatial
- attention
- executive function
What content is assessed by MoCA but not by SLUMS?
What content is assessed by SLUMS but not MoCA?
- MoCA:
- aphasia, verbal fluency
- SLUMS
- remote memory
Comparative validity of MoCA & SLUMS?
similary validity
(equivalent sensitivity, specificity, PPV & NPV)
What is the term for:
if a person has a disease, how often will the test be positive (true positive)?
Sensitivity
if a test is highly sensitive & the test is negative, you can be nearly certain that they don’t have the disease
What is the term for:
if a person does not have the disease how often will the test be negative (true negative rate)?
specificity
if the test result for a highly specific test is positive, you can be nearly certain that they actually have the disease
List the order of highest sensitivity to lowest sensitivity for SLUMS, MoCA & MMSE?
- Sensitivity:
- 92% - SLUMS (100% dementia)
- 90% - MoCA (100% dementia)
- 18% - MMSE (78% dementia)
Which cognitive screening tools have 100% sensitivity for dementia?
MoCA & SLUMS
List the order of highest specificity to lowest specificity for SLUMS, MoCA & MMSE?
- Specificity
- 100% - MMSE
- 87% - MoCA
- 81% - SLUMS
Which cognitive screening tools have 100% specificity?
MMSE
What are the indications to performa neuropsychological assessment?
- changes in memory
- poor attention and concentration
- changes in language functioning
- changes in visuospatial abilities
- impaired executive function
- changes in emotional functioning
- fluctuations in mental status
Frequently, cognitive impairment accompanies what issue?
brain dysfunction
it is a disagnostically significant feature of many neuropsychiatric disorders
Why is a “summation score” for a cognitive test not as reliable?
the undelying variability is what mght be indicative of brain dysfunction, and this variablility is lost when only a single score is assessed
What is the first step in establishing a deficit measurement?
estimate the patient’s premorbid performance level for various fuctions being assessed
What needs to be considered when establishing test norms?
demographic variables
(age, education, gender)
What is a major limitaiton of norm comparisons?
real change can only be defined by comparing present with prior functioning
What is the difference between indirect & direct deficit measurements?
- Direct
- the behavior in quesiton can be compared against n_ormative standards_
- Indirect
- compare present performance with an estimate of the patient’s original ability level, i.e.,
- historical data
- observational data
- compare present performance with an estimate of the patient’s original ability level, i.e.,
