Assessing cognition and daily function in early dementia using the cognitive-functional composite: findings from the Catch-Cog study cohort

Alzheimer's Research & Therapy

André Aleman¹  Esther M. Opmeer²  R. Vreeswijk³  R. A. J. van Deelen³  Philip Scheltens⁴  Roos J. Jutten⁴  Philippe R. Lee Meeuw Kjoe⁴  Sietske A. M. Sikkes⁵  Silvia Ingala⁶  John E. Harrison⁷  Craig W. Ritchie⁸  Frank Jan de Jong⁹ 

[1] 0000 0004 0407 1981, grid.4830.f, Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;0000 0004 0407 1981, grid.4830.f, Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;Department of Health and Social Work, University of Applied Sciences Windesheim, Zwolle, The Netherlands;0000 0004 0568 6419, grid.416219.9, Department of Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands;0000 0004 1754 9227, grid.12380.38, Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;0000 0004 1754 9227, grid.12380.38, Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;0000 0004 1754 9227, grid.12380.38, Department of Epidemiology & Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;0000 0004 1754 9227, grid.12380.38, Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;0000 0004 1754 9227, grid.12380.38, Department of Radiology and Nuclear Medicine Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;0000 0004 1754 9227, grid.12380.38, Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;Metis Cognition Ltd, Park House, Kilmington Common, Wiltshire, UK;0000 0001 2322 6764, grid.13097.3c, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK;0000 0004 1936 7988, grid.4305.2, Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK;000000040459992X, grid.5645.2, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands;

关键词: Alzheimer’s disease;    Cognition;    Composite;    Daily function;    Dementia;    Construct validation;    Instrumental activities of daily living;    Mild cognitive impairment;    Outcome measures;   

DOI  :  10.1186/s13195-019-0500-5

来源: publisher

【 摘 要 】

BackgroundThe cognitive-functional composite (CFC) was designed to improve the measurement of clinically relevant changes in predementia and early dementia stages. We have previously demonstrated its good test-retest reliability and feasibility of use. The current study aimed to evaluate several quality aspects of the CFC, including construct validity, clinical relevance, and suitability for the target population.MethodsBaseline data of the Capturing Changes in Cognition study was used: an international, prospective cohort study including participants with subjective cognitive decline (SCD), mild cognitive impairment (MCI), Alzheimer’s disease (AD) dementia, and dementia with Lewy bodies (DLB). The CFC comprises seven existing cognitive tests focusing on memory and executive functions (EF) and the informant-based Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q). Construct validity and clinical relevance were assessed by (1) confirmatory factor analyses (CFA) using all CFC subtests and (2) linear regression analyses relating the CFC score (independent) to reference measures of disease severity (dependent), correcting for age, sex, and education. To assess the suitability for the target population, we compared score distributions of the CFC to those of traditional tests (Alzheimer’s Disease Assessment Scale–Cognitive subscale, Alzheimer’s Disease Cooperative Study–Activities of Daily Living scale, and Clinical Dementia Rating scale).ResultsA total of 184 participants were included (age 71.8 ± 8.4; 42% female; n = 14 SCD, n = 80 MCI, n = 78 AD, and n = 12 DLB). CFA showed that the hypothesized three-factor model (memory, EF, and IADL) had adequate fit (CFI = .931, RMSEA = .091, SRMR = .06). Moreover, worse CFC performance was associated with more cognitive decline as reported by the informant (β = .61, p < .001), poorer quality of life (β = .51, p < .001), higher caregiver burden (β = − .51, p < .001), more apathy (β = − .36, p < .001), and less cortical volume (β = .34, p = .02). Whilst correlations between the CFC and traditional measures were moderate to strong (ranging from − .65 to .83, all p < .001), histograms showed floor and ceiling effects for the traditional tests as compared to the CFC.ConclusionsOur findings illustrate that the CFC has good construct validity, captures clinically relevant aspects of disease severity, and shows no range restrictions in scoring. It therefore provides a more useful outcome measure than traditional tests to evaluate cognition and function in MCI and mild AD.

【 授权许可】

CC BY