Dooley Suzanna, Hopper Tammy, Doyle Rachael, Gilheaney Orla, Walshe Margaret
St. Columcille's Hospital, Dublin, Ireland.
Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland.
Int J Lang Commun Disord. 2025 Jan-Feb;60(1):e13153. doi: 10.1111/1460-6984.13153.
BACKGROUND: Individuals with dementia have communication limitations resulting from cognitive impairments that define the syndrome. Whereas there are numerous cognitive assessments for individuals with dementia, there are far fewer communication assessments. The Profiling Communication Ability in Dementia (P-CAD) was developed to address this gap. AIMS: The purpose of this study was to examine the concurrent validity, longitudinal validity and inter- and intra-rater reliability of the P-CAD in a population of people with dementia and their communication partners. METHOD: The P-CAD was administered to 122 people with dementia and their communication partners in Ireland (n = 100) and Canada (n = 22), over a 12-month period. To establish concurrent validity of the P-CAD, scores were compared to scores obtained from existing standardized instruments including the Functional Linguistic Communication Inventory (FLCI), the Mini-Mental State Examination (MMSE-2) and Global Deterioration Scale (GDS). Inter-rater reliability and responsiveness (longitudinal validity) were analysed using data from a subgroup of participants. OUTCOMES & RESULTS: Overall P-CAD test scores were significantly correlated with FLCI (n = 122; r = 0.875; p < 0.001) and MMSE-2 total scores (n = 122; r = 0.857; p < 0.001). Levels of communication support categories on the P-CAD correlated with GDS rankings (n = 122; rho = -0.539; p < 0.001) and MMSE-2 total scores (n = 122; rho = 0.680, p < 0.001). Inter-rater reliability tested for 20 participants in the Irish sample revealed high levels of agreement between raters in scoring the GDS (n = 20; ICC = 0.969, p < 0.001), MMSE-2 (n = 20; ICC = 0.997, p < 0.001), FLCI (n = 20; ICC = 0.999, p < 0.001) and P-CAD (n = 20; ICC = 0.981, p < 0.001). To establish longitudinal validity to examine if the P-CAD was responsive to changes in cognitive-communication function over time, 12 participants in the Irish sample repeated all tests 3 months after the initial testing. No statistically significant differences in test scores were found for the 12 participants who completed follow-up measures at this time point in any of the three scales. It was not possible to determine sufficient responsiveness as correlations between the change in P-CAD scores over 3 months were insignificant for both the change in MMSE-2 scores (rho = -0.130, p = 0.704) and the FLCI scores (rho = 0.221, p = 0.513). CONCLUSIONS & IMPLICATIONS: In this study, P-CAD has demonstrated good concurrent validity and inter-rater reliability in samples collected in two countries with English-speaking participants. The P-CAD is appropriate for use to evaluate communication abilities of people with dementia, including during conversational interactions with caregivers. WHAT THIS PAPER ADDS: What is already known on the subject Dementia alters the communication function of the person with dementia and impacts interactions with others. Speech and language therapists (SLTs) provide specific recommendations on communication function and support. However, they have limited access to comprehensive communication assessments to guide intervention. What this paper adds to the existing knowledge This validation study has confirmed that Profiling Communication Ability in Dementia (P-CAD) is a valid and reliable tool for SLTs to profile the communication abilities of people with dementia. It identifies the type and levels of communication support required as dementia progresses. The inclusion of communication partners in the study confirms their important role in providing conversation support to people with dementia. What are the potential or clinical implications of this work? The P-CAD is a clinical resource for dynamic communication assessment, which identifies key areas of retained ability to guide communication support and individualised intervention. It can be used with people at different stages and severity of dementia across a range of clinical settings. The P-CAD summary, which is part of the P-CAD, can be shared with family members and healthcare teams to enhance communication access for the person as dementia progresses.
背景:痴呆症患者存在因认知障碍导致的沟通限制,而认知障碍正是该综合征的定义特征。虽然针对痴呆症患者有众多认知评估,但沟通评估却少得多。为填补这一空白,开发了痴呆症沟通能力剖析量表(P-CAD)。 目的:本研究旨在检验P-CAD在痴呆症患者及其沟通伙伴群体中的同时效度、纵向效度以及评分者间和评分者内信度。 方法:在12个月期间,对爱尔兰(n = 100)和加拿大(n = 22)的122名痴呆症患者及其沟通伙伴进行了P-CAD测试。为确定P-CAD的同时效度,将其得分与从现有标准化工具获得的得分进行比较,这些工具包括功能性语言沟通量表(FLCI)、简易精神状态检查表(MMSE-2)和总体衰退量表(GDS)。使用部分参与者的数据对评分者间信度和反应性(纵向效度)进行了分析。 结果:P-CAD测试总分与FLCI(n = 122;r = 0.875;p < 0.001)和MMSE-2总分(n = 122;r = 0.857;p < 0.001)显著相关。P-CAD上的沟通支持类别水平与GDS排名(n = 122;rho = -0.539;p < 0.001)和MMSE-2总分(n = 122;rho = 0.680,p < 0.001)相关。对爱尔兰样本中的20名参与者进行的评分者间信度测试显示,评分者在对GDS(n = 20;ICC = 0.969,p < 0.001)、MMSE-2(n = 20;ICC = 0.997,p < 0.001)、FLCI(n = 20;ICC = 0.999,p < 0.001)和P-CAD(n = 20;ICC = 0.981,p < 0.001)评分方面具有高度一致性。为确定纵向效度以检验P-CAD是否能反映认知沟通功能随时间的变化,爱尔兰样本中的12名参与者在初次测试3个月后重复了所有测试。在这个时间点完成后续测量的12名参与者在任何一个量表上的测试分数均未发现统计学上的显著差异。由于3个月内P-CAD分数变化与MMSE-2分数变化(rho = -0.130,p = 0.704)和FLCI分数变化(rho = 0.221,p = 0.513)之间的相关性均不显著,因此无法确定足够的反应性。 结论与启示:在本研究中,P-CAD在两个以英语为母语的国家收集的样本中显示出良好的同时效度和评分者间信度。P-CAD适用于评估痴呆症患者的沟通能力,包括在与护理人员的对话互动中。 本文补充内容:关于该主题的已知信息 痴呆症会改变痴呆症患者的沟通功能,并影响与他人的互动。言语和语言治疗师(SLT)会就沟通功能和支持提供具体建议。然而,他们获取全面沟通评估以指导干预的机会有限。本文对现有知识的补充 这项验证研究证实,痴呆症沟通能力剖析量表(P-CAD)是言语和语言治疗师评估痴呆症患者沟通能力的有效且可靠工具。它能确定随着痴呆症进展所需的沟通支持类型和水平。研究纳入沟通伙伴证实了他们在为痴呆症患者提供对话支持方面的重要作用。这项工作的潜在或临床意义是什么?P-CAD是一种用于动态沟通评估的临床资源,它能确定保留能力的关键领域,以指导沟通支持和个性化干预。它可用于不同阶段和严重程度的痴呆症患者,适用于一系列临床环境。P-CAD总结作为P-CAD的一部分,可与家庭成员和医疗团队共享,以在痴呆症进展过程中增强患者的沟通机会。
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