Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
Ralph H. Johnson Department of Veterans Affairs Medical Center, Mental Health Service, Charleston, SC, USA.
J Clin Exp Neuropsychol. 2021 Sep;43(7):753-765. doi: 10.1080/13803395.2021.2007857. Epub 2021 Dec 28.
Evidence-based practice in neuropsychology involves the use of validated tests, cutoff scores, and interpretive algorithms to identify clinically significant cognitive deficits. Recently, actuarial neuropsychological criteria (ANP) for identifying mild cognitive impairment were developed, demonstrating improved criterion validity and temporal stability compared to conventional criteria (CNP). However, benefits of the ANP criteria have not been investigated in non-research, clinical settings with varied etiologies, severities, and comorbidities. This study compared the utility of CNP and ANP criteria using data from a memory disorders clinic.
Data from 500 non-demented older adults evaluated in a Veterans Affairs Medical Center memory disorders clinic were retrospectively analyzed. We applied CNP and ANP criteria to the Repeatable Battery for the Assessment of Neuropsychological Status, compared outcomes to consensus clinical diagnoses, and conducted cluster analyses of scores from each group.
The majority (72%) of patients met both the CNP and ANP criteria and both approaches were susceptible to confounding factors such as invalid test data and mood disturbance. However, the CNP approach mislabeled impairment in more patients with non-cognitive disorders and intact cognition. Comparatively, the ANP approach misdiagnosed patients with depression at a third of the rate and those with no diagnosis at nearly half the rate of CNP. Cluster analyses revealed groups with: 1) minimal impairment, 2) amnestic impairment, and 3) multi-domain impairment. The ANP approach yielded subgroups with more distinct neuropsychological profiles.
We replicated previous findings that the CNP approach is over-inclusive, particularly for those determined to have no cognitive disorder by a consensus team. The ANP approach yielded fewer false positives and better diagnostic specificity than the CNP. Despite clear benefits of the ANP vs. CNP, there was substantial overlap in their performance in this heterogeneous sample. These findings highlight the critical role of clinical interpretation when wielding these empirically-derived tools.
神经心理学中的循证实践包括使用经过验证的测试、截断分数和解释算法来识别临床上显著的认知缺陷。最近，制定了用于识别轻度认知障碍的计算神经心理学标准（ANP），与传统标准（CNP）相比，其具有更好的标准有效性和时间稳定性。然而，在具有不同病因、严重程度和合并症的非研究、临床环境中，尚未研究 ANP 标准的益处。本研究使用记忆障碍诊所的数据比较了 CNP 和 ANP 标准的效用。
回顾性分析了在退伍军人事务医疗中心记忆障碍诊所评估的 500 名非痴呆老年人的数据。我们将 CNP 和 ANP 标准应用于重复性神经心理评估量表，将结果与共识临床诊断进行比较，并对每组的分数进行聚类分析。
大多数（72%）患者同时符合 CNP 和 ANP 标准，两种方法都容易受到无效测试数据和情绪障碍等混杂因素的影响。然而，CNP 方法会错误地标记更多患有非认知障碍和认知完整的患者的损伤。相比之下，ANP 方法将抑郁患者误诊的比例降低了三分之一，而将无诊断的患者误诊的比例降低了近一半。聚类分析显示出具有以下特征的组：1）最小损伤，2）健忘性损伤，和 3）多域损伤。ANP 方法产生了具有更独特神经心理学特征的亚组。
我们复制了之前的发现，即 CNP 方法过于广泛，特别是对于那些被共识小组确定没有认知障碍的患者。ANP 方法比 CNP 方法产生的假阳性更少，诊断特异性更好。尽管与 CNP 相比，ANP 具有明显的优势，但在这个异质样本中，它们的性能有很大的重叠。这些发现强调了在使用这些经验衍生工具时临床解释的关键作用。
