The development, pilot and validation of a multicultural cognitive assessment scale. A thesis for the Degree of Doctor of Philosophy in Public Health and Community Medicine. Joella E Storey University of New South Wales 2005 1 Table of Contents The development, pilot and validation of a multicultural cognitive assessment scale. ...................................................................................................1 Table of Contents..................................................................................................2 List of Figures .......................................................................................................6 List of Tables.........................................................................................................7 CERTIFICATE OF ORIGINALITY.................................................................9 Abstract ...............................................................................................................10 Awards and Publications ...................................................................................12 Acknowledgements.............................................................................................15 Introduction ........................................................................................................17 Chapter 1 The problem: There are no culture-fair cognitive screening tests. .....................................................................................................................20 The epidemiology of dementia.......................................................................20 Implications for the health system ................................................................22 The issue of screening for dementia..............................................................22 Screening for dementia in non-English speaking cohorts ..........................23 Defining dementia...........................................................................................24 The early detection of dementia....................................................................28 The social cost of dementia ............................................................................28 Screening for dementia: Risk stratification .................................................29 Screening for dementia: The instruments....................................................30 Screening for dementia: Accuracy and reproducibility..............................32 Screening for dementia: Problems with the instruments ..........................33 Chapter 2 Cognition..........................................................................................34 Cognition and the Philosophy of Science .....................................................34 The problem of knowledge ............................................................................36 Post-positivism ................................................................................................38 Key Influences on Current Concepts of Cognition .....................................40 Physical Sciences.........................................................................................40 Philosophy....................................................................................................41 Physiology ....................................................................................................41 2 Neuroscience, neurology and psychiatry....................................................45 Individual differences and intelligence testing ..........................................49 How do we understand cognition? The Cognitivist Paradigm..................53 Chapter 3 Cognition: Race and culture.........................................................62 Consequences of Comparative Intelligence Testing....................................62 Problems in the race argument .....................................................................65 The problem of culture and cognition ..........................................................71 The Universalistic model................................................................................78 Chapter 4 Cognition: Measurement and testing ..........................................85 Background.....................................................................................................85 Psychometrics .................................................................................................86 Cognitive impairment: Neuropsychology, clinical psychiatry and behavioral neurology......................................................................................89 Neuropsychology .........................................................................................89 Behavioural neurology and neuropsychiatry .............................................92 Chapter 5 Literature review of brief cognitive screening instruments .......96 First Generation Brief Cognitive Screening Tests - To 1990......................96 The Face-Hand Test (FHT)........................................................................96 Mental Status Questionnaire (MSQ) ..........................................................96 Information-Memory-Concentration Test (IMCT)....................................97 SET Test.......................................................................................................97 Abbreviated Mental Test (AMT) .................................................................98 Mini-Mental State Examination (MMSE) .................................................99 Short Portable Mental Status Questionnaire (SPMSQ) and the Mental Status Questionnaire (MSQ).....................................................................100 Cognitive Capacity Screening Examination (CCSE)...............................100 Function, Reason, Orientation, Memory, Arithmetic, Judgment, and Emotional Status (FROMAJE).................................................................101 Global Deterioration Scale (GDS) ............................................................102 Brief Cognitive Rating Scale (BCRS).......................................................102 Short Blessed Test (SBT)...........................................................................103 Modified Mini-Mental State (3MS) ..........................................................103 Neurobehavioral Cognitive Status Examination (NCSE) (Cognistat)....104 Second Generation Brief Cognitive Screening Tests – 1990 to 2005 .......105 Halifax Mental Status Schedule (HMSS) ................................................105 Short Test of Mental Status (STMS).........................................................106 Standardized Mini-Mental State Examination (SMMSE).......................107 WORLD Test..............................................................................................108 Time and Change Test (T&C Test)...........................................................108 7 Minute Screen (7MS) .............................................................................109 3 Memory Impairment Screen (MIS) ..........................................................109 Short and Sweet Screening Instrument (SAS-SI) ....................................111 General Practitioner Assessment of Cognition (GPCOG).......................111 DemTect (DemTect)...................................................................................112 Rapid Dementia Screening Test (RDST)..................................................113 Clock Drawing Tests ....................................................................................119 Cross-cultural cognitive tests.......................................................................121 Fuld Object-Memory Evaluation (FOME)...............................................121 Cognitive Abilities Screening Instrument (CASI)....................................122 Elderly Cognitive Assessment Questionnaire (ECAQ) ............................123 Cross Cultural Cognitive Examination (CCCE) ......................................123 Community Screening Interview for Dementia (CSI’D) .........................124 Mini-Cog....................................................................................................125 Chapter 6 Study 1: Clock drawing. Is it a useful multicultural cognitive screening instrument?......................................................................................134 Method...........................................................................................................134 Study Participants......................................................................................134 Measures ....................................................................................................137 Clock Scoring.............................................................................................137 Statistical analyses.....................................................................................140 Results............................................................................................................140 Characteristics of patients.........................................................................140 Reliability ...................................................................................................141 Area under ROC curve (AUC), sensitivity, specificity and 95% confidence intervals......................................................................................................141