IS THE CAMBRIDGE COGNITIVE TEST (CAMCOG) A USEFUL TOOL TO PREDICT THE PATHOLOGICAL STATUS OF CEREBROSPINAL FLUID IN PATIENTS. Screening Test s. Mini Mental State Examination (MMSE). 12 (52). Cambridge Cognitive Examination (CAMCOG). 8 (35). Middlesex Elderly Assessment of. A leading global provider of cognitive assessment software for use in: • Academic Research – Promoting products for use in Academic Research since
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It was applied on elders and retested at a mean interval of The intraclass coefficient for the set of items and for the subscales varied from 0. In the retests the agreement was nearly perfect for the set of items. There was no expressive range in the stability of the instrument for sex, age, schooling, or for the presence of dementia. The Cronbach’ alpha of the set of items of the test was high 0. The Br-CAMCOG-R has obtained a high level of stability with time, agreement among raters, and optimum internal consistency; it can be useful for epidemiological studies and in specialized clinics to evaluate cognitive functions in elders.
O alfa de Cronbach para o conjunto dos itens do teste foi alta 0, The use of reliable and valid instruments to evaluate cognition of the elderly with memory complaints provides more accurate and reproductive diagnosis, making it possible for the health professional to be able to trace therapeutic goals based on objective results.
It also allows comparisons between different populations, therefore helping to standardize procedures in clinical and epidemiological studies 1. Although there is no standard neuropsychological test for the diagnosis of dementia, exists several instruments used for this purpose. Neuropsychological batteries of tests are widely used to evaluate subjects who tested positive in the screening examinations. The lack of a specific biological marker for the diagnosis of dementia in the clinical practice amplifies the vitality of this evaluation 2.
Among the brief neuropsychological batteries mentioned in the literature, the Cambridge Cognitive Examination CAMCOG has the advantage of offering a summary measurement of the global cognitive function, allowing changes at cutoff score according to age and schooling 3,4.
It has incorporated a few screening instruments for cognitive disturbances widely used in epidemiological research, such as the Mini-Mental State Examination MMSE 6and 8 of the 10 items of the Hodgkinson Abbreviated Mental Test 7.
The instrument is composed of 69 items with a maximum score of points; the higher the total score, the better the performance in the test. The complexity of the instrument demands training for the raters and the copyright is reserved by the Cambridge University Press. In Brazil, the only study found by the authors which validates instruments from this country’ perspective was the one written by Bottino et al. The interrater reliability, which was evaluated using the ICC, proved to be high, varying from 0.
The objective of the present study is to evaluate the interrater reliability and test-retest as well as the internal consistency of the Br-CAMCOG-R, as one of the vital steps in the evaluation process of the psychometric properties of this instrument.
This study took place in a public geriatric outpatient clinic in Rio de Janeiro, Brazil. The source population was composed of 1, elders who attended the clinic between May 2 nd and December 28 th A research team examined the records of the subjects who would be treated and selected those who fulfilled the eligibility criteria.
Reliability of the Brazilian version of the Cambridge Cognitive Examination Revised CAMCOG-R
On the appointment day, the selected subjects were invited to participate in the study. The first 60 subjects tested were also used to assess the interrater reliability of the instrument.
On retest invitation out of subjects returned. The inclusion criteria were: The exclusion criteria were: As for the evaluation of the interrater reliability, two raters applied the test and both of them wrote down the answers separately. The raters were not allowed to discuss their doubts, which were answered later by the coordinator of the survey.
The test-retest reliability was evaluated with a mean interval of Instrument application and the evaluated variables.
The test text was done by one of the five trained examiners for the study: The testing took place in a reserved room, well lit, with damcog external noise, and with no visible calendars or clocks. Each subject submitted to the test sat on a chair at a table used as a surface upon which to write or draw, and in case he or she wore eyeglasses, was asked to wear them. The patient’ schooling was defined as completed years of school in the formal educational system as informed by the subject failed school years were not taken into consideration.
They were then divided in the following categories: The age taken into consideration was based on any identification document presented, and it was divided into: All subjects underwent a comprehensive geriatric assessment consisting of a functional teet a cognitive evaluation, as well as of an interview with an informant.
The functional evaluation consisted of applying both the evaluation scale of the daily life basic activities 17 and of the daily life instrumental activities 18both in the subject as well as in the informant, with divergencies in the information written down and commented by the rater.
The diagnosis of dementia was given by the geriatrician who assisted the subject based tesg DSM-IV criteria.
As the “attention” and the “calculation” subscales are very small each having only two itemstes were analyzed together with a maximum value of 9 points. In the test-retest study, analyses were made after sample stratification by sex, age, schooling, and the presence of dementia.
Teest the interpretation of values, the criteria proposed by Landis and Kock 22 were taken into consideration: The data was typed and analyzed using SPSS One hundred and twenty-three subjects took part in the test-retest study, while 60 of them participated in camcoog interrater reliability study as well.
The internal consistency of the set of items of the test was high: In the test-retest reliability study, In the retest, the mean time was The stability of the instrument with time did not vary between males and females and or damcog or without dementia.
However, a small tes was found for subjects with low schooling Table 4. Camcgo differences were noticed in the ICC values for the tets items after sex, age, and schooling stratification.
According to the dementia diagnosis, the “perception” and “executive functions” subscales obtained a higher ICC among the non-cases, while in the “attention and calculation” subscale, the ICC was higher among the cases Table 4.
The subscale means camcot similar in the two testings; a discreet difference was noticed in the “executive functions” subscale and in the MMSE. The ICC score was excellent for the set of items of the test and for the items of the subscales; it varied from “moderate” 0. There was no significant range in the stability of the instrument in sex, age, schooling, or the presence of dementia.
The internal consistency for the testt of items in the test was 0. Different comprehensive evaluation instruments have been developed to assess cognitive dysfunctions in the field of neuropsychology, as it cmcog the case with the CAMCOG-R; neuropsychological test batteries are made up of instruments utilized to evaluate several cognitive functions.
When a subject answers one item correctly, it is expected that he or she would also be able to answer other items related to it correctly as well, because split cognition into cognitive domains is more didactical than anatomical, since the brain operates in a network where one area is intimately connected with the other Bearing in mind the multidimensionality of the construct named cognition, the internal consistency of the instruments used to evaluate it should reflect the agreement or not of each item with the test as a whole.
When evaluating the stability of an instrument, it is fundamental to guarantee that the variability of the results is not significantly determined by the range associated to the rater, which can occur due to the precarious standardization while applying it. The high interrater reliability found in the present study suggests that, despite its complexity and the dependence on the raters’ evaluation of some items, the variability associated to the rater did not jeopardize the instrument’ reliability.
The operational difficulties during the interrater reliability study, which demanded the presence of two raters in the interview room at the same time, caused the studied sample to be smaller than that of the test-retest. However, it does not seem to us that this fact jeopardized the quality of the results, since similar studies were made with damcog containing 40 to 55 subjects 8, Another source of tst which may risk the stability of an instrument is the change of the studied phenomenon.
The high reliability of the test-retest found in the present study suggests that the instrument has an excellent level of stability with time, for both the set of items in the test and for the majority of the camxog in the subscales.
The data suggest that the studied phenomenon – cognition – was kept stable during the period of time in which it was studied. The cmacog subscale demonstrated the smallest stability in time Table 4. This finding can be partially explained by the fact that the punctuation of the items which constitute the subscale depends on the raters’ interpretation.
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It is made up of camdog which require the copying of drawings and the producing of a freehand drawing of a clock without copying. The stability of the total score of the instrument in tset was adequate, even after the stratification by sex, age, schooling, and the presence of dementia; the difference in the ICC scores for the test’ set of items and for most subscales was discreet, suggesting the instrument maintains its stability in time even in subjects with cognition impairment.
These findings corroborate those of Lindeboom et al. The stability of the instrument among those with mild, moderate and severe dementia was 0. The camcpg mean in the retest was discreetly higher than in the test, which showed a possible learning effect, already noticed in similar studies with different cognitive instruments A few general methodological aspects deserve comments when examining the reliability of a rating process, principally of the interrater type.
One aspect has to do with the raters who, aware of the evaluation process in course, tend to proceed more rigorously than in everyday circumstances, which may provide for an overestimation of the reliability results. The other aspect is the raters’ tendency to alter their approach with time, in such a way as to improve the way they ask the questions and relate to the respondents, in case the application of an instrument takes a long time In the interrater reliability study, the minimum age of the subjects was 65 years; for tesst reason, it was not possible to test the items of the remote memory subscale suggested for subjects who were born after Other study limitations were that most of the subjects had teest schooling, were under 85 years old, and attended a public health clinic, making the sample a homogeneous one, but not representative of the Brazilian elderly population as a whole.
Ongoing additional criteria validity studies should complete the measurement equivalence of the Brazilian version of the test. However, we suggest reapplying this study in different operational settings to learn about the stability of the instrument in other circumstances.
We reach the conclusion that the Br-CAMCOG-R has high levels of stability with time, agreement among raters, and very good internal consistency and, as such, it can be useful in epidemiological studies and in specialized clinics to evaluate cognitive functions in elders. Clinical and neuropsychological assessment of Alzheimer’ disease.
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