Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Economics, University of Missouri, Columbia, Missouri, USA.
J Neuropsychol. 2023 Mar;17(1):108-124. doi: 10.1111/jnp.12289. Epub 2022 Sep 19.
We examined the impact of conventional versus robust normative approaches on cognitive characterization and clinical classification of MCI versus dementia. The sample included participants from the National Alzheimer's Coordinating Center Uniform Data Set. Separate demographically adjusted z-scores for cognitive tests were derived from conventional (n = 4273) and robust (n = 602) normative groups. To assess the impact of deriving scores from a conventional versus robust normative group on cognitive characterization, we examined likelihood of having a low score on each neuropsychological test. Next, we created receiver operating characteristic (ROC) curves for the ability of normed scores derived from each normative group to differentiate between MCI (n = 3570) and dementia (n = 1564). We examined the impact of choice of normative group on classification accuracy by comparing sensitivity and specificity values and areas under the curves (AUC). Compared with using a conventional normative group, using a robust normative group resulted in a higher likelihood of low cognitive scores for individuals classified with MCI and dementia. Comparison of the classification accuracy for distinguishing MCI from dementia did not suggest a statistically significant advantage for either normative approach (Z = -0.29, p = .77; AUC = 0.86 for conventional and AUC = 0.86 for robust). In summary, these results indicate that using a robust normative group increases the likelihood of characterizing cognitive performance as low. However, there is not a clear advantage of using a robust over a conventional normative group when differentiating between MCI and dementia.
我们研究了传统规范方法与稳健规范方法对 MCI 与痴呆认知特征和临床分类的影响。该样本包括来自国家阿尔茨海默病协调中心统一数据集的参与者。从传统（n=4273）和稳健（n=602）规范组分别得出认知测试的经过人口统计学调整的 z 分数。为了评估从传统规范组与稳健规范组获得分数对认知特征的影响，我们检查了每个神经心理学测试得分低的可能性。接下来，我们为每个规范组衍生的规范分数区分 MCI（n=3570）和痴呆（n=1564）的能力创建了接收者操作特征（ROC）曲线。我们通过比较敏感性和特异性值以及曲线下面积（AUC），来检查选择规范组对分类准确性的影响。与使用传统规范组相比，使用稳健规范组导致 MCI 和痴呆分类个体的认知得分较低的可能性更高。比较区分 MCI 与痴呆的分类准确性并未表明两种规范方法都具有统计学优势（Z=-0.29，p=0.77；传统方法的 AUC=0.86，稳健方法的 AUC=0.86）。总之，这些结果表明，使用稳健规范组增加了将认知表现特征化为低的可能性。然而，在区分 MCI 和痴呆时，使用稳健规范组并没有明显优于传统规范组的优势。
