Department of Clinical Epidemiology, Biostatistics and Bioinformatics Academic Medical Centre, Amsterdam, The Netherlands.
J Alzheimers Dis. 2011;25(4):595-603. doi: 10.3233/JAD-2011-101743.
Longer cognitive tests, such as the Alzheimer's disease assessment scale (ADAS-cog) or the Cambridge cognitive examination (CAMCOG), are more precise but less efficient than briefer tests, such as the Mini Mental State Examination (MMSE). We examined if computerized adaptive testing (CAT) of cognitive impairment can combine brevity with precision by tailoring a precise test to each individual patient. We conducted a prospective study of 84 participants [normal aging, n = 41; mild cognitive impairment (MCI), n = 21; dementia, n = 22]. CAT estimated a participant's ability during testing by selecting only items of appropriate difficulty from either the CAMCOG or the CAMCOG supplemented with ADAS-cog items and neuropsychological tests (the CAMCOG-Plus). After tailored testing with CAT, the remaining CAMCOG and CAMCOG-Plus items not selected by CAT were administered. The time needed to complete the CAT was compared to that needed for the whole CAMCOG and CAMCOG-Plus. Results showed that testing time reductions achieved with CAT were 37% or more compared to the whole CAMCOG and 55% or more compared to the whole CAMCOG-Plus. Estimated ability levels with CAT were in excellent agreement with those based on the whole CAMCOG and CAMCOG-Plus (intraclass correlations 0.99 and 0.98, respectively). Diagnostic accuracy of detecting mild dementia and MCI seemed better for the CAT administered tests than for the MMSE, but the differences were not significant. We conclude that adaptive testing combines brevity with precision, especially in grading the severity of cognitive impairment.
更长的认知测试，如阿尔茨海默病评估量表（ADAS-cog）或剑桥认知测验（CAMCOG），比简短的测试（如简易精神状态检查（MMSE））更精确但效率更低。我们研究了认知障碍的计算机自适应测试（CAT）是否可以通过为每个患者量身定制精确的测试来将简洁与精确相结合。我们对 84 名参与者进行了前瞻性研究[正常老化，n = 41；轻度认知障碍（MCI），n = 21；痴呆，n = 22]。CAT 通过从 CAMCOG 或 CAMCOG 中选择适当难度的项目，或从 CAMCOG 加上 ADAS-cog 项目和神经心理学测试（CAMCOG-Plus）中选择适当难度的项目，来评估参与者在测试期间的能力。经过 CAT 的针对性测试后，剩余的 CAT 未选择的 CAMCOG 和 CAMCOG-Plus 项目将进行管理。比较完成 CAT 所需的时间与完成整个 CAMCOG 和 CAMCOG-Plus 所需的时间。结果表明，与整个 CAMCOG 相比，CAT 可减少 37%或更多的测试时间，与整个 CAMCOG-Plus 相比，CAT 可减少 55%或更多的测试时间。CAT 估计的能力水平与基于整个 CAMCOG 和 CAMCOG-Plus 的能力水平非常一致（分别为 0.99 和 0.98 的组内相关系数）。与 MMSE 相比，CAT 管理的测试在检测轻度痴呆和 MCI 方面的诊断准确性似乎更好，但差异无统计学意义。我们的结论是，自适应测试将简洁与精确相结合，特别是在评估认知障碍的严重程度方面。
