Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Arch Clin Neuropsychol. 2019 Oct 24;34(7):1156-1164. doi: 10.1093/arclin/acz033.
The Neuropsychological Assessment Battery Bill Payment subtest has shown strong diagnostic accuracy in dementia due to Alzheimer's disease (AD) versus non-AD. Its relationship to mild cognitive impairment (MCI) or all-cause dementia has not been fully examined nor has its ecological validity as a proxy of financial independence.
We describe 270 women (63%) and men (age = 72 ± 8.39) who completed Bill Payment during outpatient neuropsychological evaluation. Seventy-one were cognitively normal (CN), 160 had MCI, and 39 had Dementia. Two hundred fourteen were independent in money management, 31 were assisted (had oversight/some help), and 25 were dependent (relied on others). Receiver operating characteristic (ROC) curves tested Bill Payment's utility as a dementia screen. Kruskal-Wallis tests examined whether Bill Payment differed by levels of financial independence.
At a cutoff of 17, Bill Payment had strong sensitivity (0.87) and specificity (0.80) for dementia versus CN cases. A cutoff of 15 distinguished dementia from MCI (Sn = 0.64, Sp = 0.85), whereas a cutoff of 16 distinguished dementia from functionally unimpaired cases (MCI + CN) with greater sensitivity and similar specificity (Sn = 0.74, Sp = 0.81). Sensitivity attenuated in MCI versus CN cases (Sn = 0.46, Sp = 0.83). Those who were independent in money management had higher scores than assisted and dependent cases (p ≤ 0.046). Assisted and dependent cases were no different (p > 0.05).
Bill Payment is a valid screen of all-cause dementia. Lower Bill Payment scores may mark subtle functional decline beyond cognitive impairment alone. Specifically, results provide preliminary evidence of Bill Payment's ecological validity as a measure related to financial independence. It may prove useful when impaired financial abilities are suspected but unreported.
神经心理评估电池账单支付子测试在阿尔茨海默病（AD）引起的痴呆与非 AD 患者中具有很强的诊断准确性。但其与轻度认知障碍（MCI）或所有原因痴呆的关系尚未得到充分研究，其作为财务独立代理的生态有效性也尚未确定。
我们描述了 270 名女性（63%）和男性（年龄=72±8.39 岁）在门诊神经心理评估期间完成了账单支付。71 名认知正常（CN），160 名患有 MCI，39 名患有痴呆。214 名在财务管理方面独立，31 名需要协助（有监督/一些帮助），25 名依赖他人（依赖他人）。接收者操作特征（ROC）曲线测试了账单支付作为痴呆筛查的效用。克鲁斯卡尔-沃利斯检验检查了账单支付是否因财务独立程度的不同而有所不同。
在截止值为 17 时，账单支付对痴呆与 CN 病例的敏感性（0.87）和特异性（0.80）均较强。截止值为 15 可区分痴呆与 MCI（Sn=0.64，Sp=0.85），而截止值为 16 可区分痴呆与功能未受损病例（MCI+CN），其敏感性更高，特异性相似（Sn=0.74，Sp=0.81）。MCI 与 CN 病例相比，敏感性减弱（Sn=0.46，Sp=0.83）。在财务管理方面独立的人得分高于需要协助和依赖的人（p≤0.046）。协助和依赖的人没有差异（p>0.05）。
账单支付是一种有效的全因痴呆筛查工具。较低的账单支付分数可能标志着除认知障碍外，功能的微妙下降。具体来说，结果初步证明了账单支付作为与财务独立相关的衡量标准的生态有效性。当怀疑但未报告财务能力受损时，它可能很有用。
