Περίληψη σε άλλη γλώσσα
Introduction: Due to the aging of population the importance of prompt and accurate detection of cognitive improvment in older adults has increased, as this detection is the first step in diagnosing major and mild neurocognitive disorders. Face-to-face administrition of detailed and thorough neurocognitive tests is both time consuming and costly. During the last decades telephone-based new neurocognitive tests embody a valuable tool in epidemiological studies for follow-up assessments or reexaminations in clinical trials as well as within frames of daily clinical practice in the COVID-19 pandemic crisis. At least 19 telephone-based neurocognitive tests are available today. They differ with regard to as far as the administration time the number of cognitive fields they access examined, the thoroughness of this cognitive assessment, their specifity and the sensitivity in detecting cognitive deficits of note, no telephone scale has been either translated into Greek or validated in a Greek ...
Introduction: Due to the aging of population the importance of prompt and accurate detection of cognitive improvment in older adults has increased, as this detection is the first step in diagnosing major and mild neurocognitive disorders. Face-to-face administrition of detailed and thorough neurocognitive tests is both time consuming and costly. During the last decades telephone-based new neurocognitive tests embody a valuable tool in epidemiological studies for follow-up assessments or reexaminations in clinical trials as well as within frames of daily clinical practice in the COVID-19 pandemic crisis. At least 19 telephone-based neurocognitive tests are available today. They differ with regard to as far as the administration time the number of cognitive fields they access examined, the thoroughness of this cognitive assessment, their specifity and the sensitivity in detecting cognitive deficits of note, no telephone scale has been either translated into Greek or validated in a Greek population, while the Cognitive Telephone Screening Instrument (COGTEL) has not been administered in older adults with major or mild neurocognitive disorder (MaND and MiND respectively) yet.Aim: The present study aims to evaluate a) the usefulness of COGTEL and COGTEL+, which is enriched with orientation items, in detecting MiND and MaND due to Alzheimer Disease (AD) and compare it to the Modified Mini-Mental State Examination (3MS) and b) the accuracy of face-to-face COGTEL administration compared to COGTEL administered via telephone.Materials and Methods: The study sample encompassed 197 individuals without cognitive impairment, 95 patients with MiND and 65 with MaND due to AD. In 20 participants, COGTEL was also administered in both face to-face and over the telephone sessions. Differences across the three study groups, i.e., individuals without cognitive impairment, patients with MiND and patients with MaND, in sex distribution, age, education and test scores were assessed with Pearson Chi-square test, Kruskal Wallis test, Wilcoxon–Mann–Whitney test, as appropriate, since data normality assumption was rejected based on analysis of skewness and kurtosis. Three proportional odds logistic regression models (POLR models) were employed for studying the relationship between diagnostic groups (served as the ordinal dependent variable) and each one of the three different instruments (COGTEL, COGTEL+ and 3MS) taking into account age, sex, and education, which influence cognitive function in older adults. Stratified repeated random subsampling (stratified bootstrap resampling) was used to recursive partitioning to training and validation set (70/30 ratio). The procedure was repeated 20,000 times and the results were then averaged over the splits. Kernel Fisher discriminant analysis models were also employed to compare the capacity of the three instruments to separate correctly the three diagnostic groups. The accuracy of face-to-face COGTEL administration was evaluated and compared to scores of COGTEL administered over the telephone using an appropriate F-test. The impact of the time interval (in days) between the assessments on individual performance on COGTEL was assessed with a multiple linear regression model with performance on COGTEL administered over the telephone as dependent variable and time interval and performance on COGTEL administered in face-to-face sessions as independent variables.Results: Age significantly pertained to diagnostic group in all three models. Regarding sex, women were classified into less severe diagnostic categories than men with the same characteristics. Education was significantly associated with diagnostic category only in the model which included 3MS, since the 5% bootstrap confidence intervals for the other two models contained zero. As expected, higher performance on the studied cognitive instruments pertained to less severe diagnostic category in all models.Differences in misclassification errors between 3MS, COGTEL, and COGTEL+ were unveiled. The POLR models including COGTEL+ and 3MS as dependent variables outperformed the models with COGTEL as dependent variable. Interestingly, except for the validation POLR models including COGTEL in which the average misclassification error slightly exceeded 15%, in all other cases the average misclassification errors (%) were lower than 15% pointing to high classificatory utility of the models. According to the results of the discriminant analysis, the cut off values for detecting MaND and MiND due to AD were 68.5 and 90.3 for 3MS, 9.8 and 21.8 for COGTEL, 15.2 and 27.6 for COGTEL+. The misclassification error was 14.6%, 15.7%, and 12.6% for 3MS, COGTEL and COGTEL+, respectively.The analysis did not unravel a significant effect of administration modality on participant performance on the Greek version of COGTEL. The two administration modalities showed a very strong linear relationship (B = 0.964, p < 0.001), while time interval between the assessments was not found to pertain to performance on COGTEL administered in face-to-face sessions (B = –0.072, p = 0.610) according to the multiple regression model which explained 93.81% of variation of performance on COGTEL administered over the telephone (F(2.17) = 128.78, p < 0.001). The findings indicate that compared to administration over the telephone, face-to-face COGTEL administration yields accurate scores and does not result in a systematic over- or underestimation of performance on COGTEL.Conclusions: The observations of the present study demonstrated the clinical utility particularly of the COGTEL+ in detecting not only MaND but also MiND caused by AD. COGTEL+ brevity, content validity, user friendliness, wide range of possible scores and lack of ceiling effects make it a valuable instrument that can be administered in face-to-face or telephone sessions.
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