Brief version of the CAMCOG for illiterate older adults with Alzheimer’s dementia

Juliana Francisca Cecato; Everton Balduino; José Eduardo Martinelli; Ivan Aprahamian

doi:10.1590/0004-282X-ANP-2020-0473

Arquivos de Neuro-Psiquiatria, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(10): 864-870
DOI: 10.1590/0004-282X-ANP-2020-0473

Article

Brief version of the CAMCOG for illiterate older adults with Alzheimer’s dementia

Versão breve do CAMCOG para idosos analfabetos com doença de Alzheimer

Authors

Juliana Francisca Cecato

¹Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.

²Universidade São Francisco, Departamento de Psicologia, Bragança Paulista SP, Brazil.
Everton Balduino

¹Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.
José Eduardo Martinelli

¹Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.
Ivan Aprahamian

¹Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.

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.

Keywords:

Alzheimer Disease - Education - Neuropsychological Tests - Aging

Palavras-chave:

Doença de Alzheimer - Educação - Testes Neuropsicológicos - Envelhecimento

Volltext

Referenzen

References
1 Fritsch T, McClendon MJ, Smyth KA, Ogrocki PK. Effects of educational attainment and occupational status on cognitive and functional decline in persons with Alzheimer-type dementia. Int Psychogeriatr. 2002 Dec;14(4):347-63. https://doi.org/10.1017/s1041610202008554
2 Lee WJ, Liang CK, Peng LN, Chiou ST, Chen LK. Protective factors against cognitive decline among community-dwelling middle-aged and older people in Taiwan: A 6-year national population-based study. Geriatr Gerontol Int. 2017 Apr;17 Suppl 1:20-7. https://doi.org/10.1111/ggi.13041
3 Balduino E, Melo BAR, Sousa LSM, Martinelli JE, Cecato JF. The “Superagers” construct in clinical practice: neuropsychological assessment of illiterate and educated elderly. Int Psychogeriatr. 2019 Sep;32(2):191-8. https://doi.org/10.1017/S1041610219001364
4 Kremen WS, Beck A, Elman JA, Gustavson DE, Reynolds CA, Tu XM, et al. Influence of young adult cognitive ability and additional education on later-life cognition. Proc Natl Acad Sci U S A. 2019 Feb;116(6):2021-6. https://doi.org/10.1073/pnas.1811537116
5 Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug;396(10248):413-46. https://doi.org/10.1016/S0140-6736(20)30367-6
6 Stern Y. Cognitive reserve. Neuropsychologia. 2009 Aug;47(10):2015-28. https://doi.org/10.1016/j.neuropsychologia.2009.03.004
7 Julayanont P, Ruthirago D. The illiterate brain and the neuropsychological assessment: from the past knowledge to future new instruments. Appl Neuropsychol Adult. 2018 Mar-Apr;25(2):174-87. https://doi.org/10.1080/23279095.2016.1250211
8 Barulli D, Stern Y. Efficiency, capacity, compensation, maintenance, plasticity: emerging concepts in cognitive reserve. Trends Cogn Sci. 2013 Oct;17(10):502-9. https://doi.org/10.1016/j.tics.2013.08.012
9 Paradela EM, Lopes CS, Lourenço RA. Reliability of the Brazilian version of the Cambridge Cognitive Examination Revised CAMCOG-R. Arq Neuro-Psiquiatr. 2009 Jun;67(2B):439-44. https://doi.org/10.1590/S0004-282X2009000300013
10 Paradela EM, Lourenço RA. Is the Cambridge Cognitive Examination - revised a good tool for detection of dementia in illiterate Brazilian older adults? Geriatr Gerontol Int. 2014 Oct;14(4):763-8. https://doi.org/10.1111/ggi.12161
11 UNESCO – UIS (Unesco Institute for Statistics). Education metadata from UIS Statistical. 2019 [accessed on Jun 16, 2020]. Available at: http://data.uis.unesco.org.
12 Columbia Center of Sustainable Investment. Emerging Market Global Players (EMGP). 2018 [accessed on Jun 16, 2020]. Available at: http://ccsi.columbia.edu/files/2013/10/EMGP.pdf
13 Ardila A, Bertolucci PH, Braga LW, Castro-Caldas A, Judd T, Kosmidis MH et al. Illiteracy: the neuropsychology of cognition without reading. Arch Clin Neuropsychol. 2010 Dec;25(8):689-712. https://doi.org/10.1093/arclin/acq079
14 Aprahamian I, Martinelli J, Cecato J, Izbicki R, Yassuda M. Can the CAMCOG be a good cognitive test for patients with Alzheimer’s disease with low levels of education? Int Psychogeriatr. 2011 Feb;23(1):96-101. https://doi.org/10.1017/S104161021000116X
15 Nunes PV, Diniz BS, Radanovic M, Abreu ID, Borelli DT, Yassuda MS, et al. CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. Int J Geriatr Psychiatry. 2008 Nov;23(11):1127-33. https://doi.org/10.1002/gps.2038
16 Aprahamian I, Diniz BS, Izbicki R, Radanovic M, Nunes PV, Forlenza OF. Optimizing the CAMCOG test in the screening for mild cognitive impairment and incipient dementia: saving time with relevant domains. Int J Geriatr Psychiatry. 2011 Apr;26(4):403-8. https://doi.org/10.1002/gps.2540
17 McKhann G, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas C, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011 May;7(3):263-9. https://doi.org/10.1016/j.jalz.2011.03.005
18 American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Association.; 2013.
19 Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-1983;17(1):37-49. https://doi.org/10.1016/0022-3956(82)90033-4
20 Roth M, Tym E, Mountjoy CQ, Huppert FA, Hendrie H, Verma S, Goddard R. CAMDEX. A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry. 1986 Dec;149:698-709. https://doi.org/10.1192/bjp.149.6.698
21 Brucki S, Nitrini R, Caramelli P, Bertolucci P, Okamoto I. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuro-Psiquiatr. 2003 Sep;61(3-B):777-81. https://doi.org/10.1590/S0004-282X2003000500014
22 Folstein MF, Folstein SE, McHugh P. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. https://doi.org/10.1016/0022-3956(75)90026-6
23 Pfeffer RI, Kurosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982 May;37(3):323-9. https://doi.org/10.1093/geronj/37.3.323
24 Chen A, Akinyemi RO, Hase Y, Firbank MJ, Ndunq’u MN, Foster V, et al. Frontal white matter hyperintensities, clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia. Brain. 2016 Jan;139(Pt 1):242-58. https://doi.org/10.1093/brain/awv328
25 Stephan BCM, Minett T, Muniz-Terrera G, Harrison SL, Matthews FE, Brayne C. Neuropsychological profiles of vascular disease and risk of dementia: implications for defining vascular cognitive impairment no dementia (VCI-ND). Age Ageing. 2017 Sep;46(5):755-60. https://doi.org/10.1093/ageing/afx016
26 Canneti B, Mosqueira AJ, Carreras T, Gago-Veiga AB, Onsurbe C, Ruiz M, Vivancos J. Differences in performance in CAMCOG-R domains between old and oldest old patients with Alzheimer’s disease. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2018;25(4):588-97. https://doi.org/10.1080/13825585.2017.1353679
27 Huppert FA, Brayne C, Gill C, Paykel ES, Beardsall L. CAMCOG—A concise neuropsychological test to assist dementia diagnosis: Socio-demographic determinants in an elderly population sample. Br J Clin Psychol. 1995 Nov;34(4):529-41. https://doi.org/10.1111/j.2044-8260.1995.tb01487.x
28 Moreira IFH, Bezerra AB, Sudo FK, Alves GS, Ericeira-Valente L, Tiel C, et al. CAMCOG – Valores das subescalas em idosos normais com nÍveis diferentes de escolaridade – Aspectos preliminares. Rev Bras Neurol. 2013 Jan-Mar;49(1):32-6.
29 James KA, Grace LK, Thomas KG, Combrinck MI. Associations between CAMCOG-R subscale performance and formal education attainment in South African older adults. Int Psychogeriatr. 2014 Nov;1-10. https://doi.org/10.1017/S1041610214002233
30 Gallagher D, Mhaolain AN, Coen R, Walsh C, Kilroy D, Belinski K, et al. Detecting prodromal Alzheimer’s disease in mild cognitive impairment: utility of the CAMCOG and other neuropsychological predictors. Int J Geriatr Psychiatry. 2010 Dec;25(12):1280-7. https://doi.org/10.1002/gps.2480
31 Conde-Sala JL, Garre-Olmo J, Vilalta-Franch J, Llinás-Reglá J, Turró-Garriga O, Lozano Galleto M, et al. Predictors of cognitive decline in Alzheimer’s disease and mild cognitive impairment using the CAMCOG: a five-year follow-up. Int Psychogeriatr. 2012 Jun;24(6):948-58. https://doi.org/10.1017/S1041610211002158
32 Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer’s disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds. Int Psychogeriatr. 2010 Feb;22(1):64-71. https://doi.org/10.1017/S1041610209991141
33 Amaral-Carvalho V, Caramelli P. Normative data for healthy middle-aged and elderly performance on the Addenbrooke Cognitive Examination-Revised. Cogn Behav Neurol. 2012 Jun;25(2):72-6. https://doi.org/10.1097/WNN.0b013e318259594b
34 de Araujo NB, Nielsen TR, Engedal K, Barca ML, Coutinho ES, Laks J. Diagnosing dementia in lower educated older persons: validation of a Brazilian Portuguese version of the Rowland Universal Dementia Assessment Scale (RUDAS). Braz J Psychiatry. 2018 Jul-Sep;40(3):264-9. https://doi.org/10.1590/1516-4446-2017-2284.
35 Baker DP, Salinas D, Eslinger PJ. An envisioned bridge: Schooling as a neurocognitive developmental institution. Dev Cogn Neurosci. 2012 Feb;2 Suppl 1(Suppl 1):S6-17. https://doi.org/10.1016/j.dcn.2011.12.001
36 Farfel JM, Nitrini R, Suemoto CK, Grinberg LT, Ferretti REL, Leite REP, et al. Very low levels of education and cognitive reserve: a clinicopathologic study. Neurologya. 2013 Aug;81(7):650-7. https://doi.org/10.1212/WNL.0b013e3182a08f1b
37 Rosselli M, Ardila A, Matute E, Vélez-Uribe I. Language development across the life span: A neuropsychological/neuroimaging perspective. Neurosci J. 2014;2014:585237. https://doi.org/10.1155/2014/585237.
38 Horowitz-Kraus T, Hutton JS. From emergent literacy to reading: how learning to read changes a child’s brain. Acta Paediatr. 2015 Jul;104(7):648-56. https://doi.org/10.1111/apa.13018
39 Contador I, Del Ser T, Llama S, Villarejo A, Benito-León J, Bermejo-Pareja F. Impact of literacy and years of education on the diagnosis of dementia: A population-based study. J Clin Exp Neuropsychol. 2017 Mar;39(2):112-9. https://doi.org/10.1080/13803395.2016.1204992
40 Leite KSB, Miotto EC, Nitrini R, Yassuda MS. Boston Naming Test (BNT) original, Brazilian adapted version and short forms: normative data for illiterate and low-educated older adults. Int Psychogeriatr. 2017 May;29(5):825-33. https://doi.org/10.1017/S1041610216001952
41 Indicadores Sociais de Jundiaí: Censo 2010, IPRS, Futuridade, IDSUS e Segurança Pública. 2010 [accessed on Jan 29, 2021]. Available at: https://transparencia.jundiai.sp.gov.br/wp-content/uploads/relatorio_indicadores_jundiai_2012.pdf