Additional Measures Recommended Emotional Cognitive Status

7/28/2019 Additional Measures Recommended Emotional Cognitive Status

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NINDS Stroke Common Data Element (CDE) Project

Stroke Outcomes and End Points Subgroup:

Recommendations

Overview

The instruments recommended here are largely consistent with thoserecommended by the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards 1,with some minor changes. Validation of the long harmonization battery is inprocess which may inform the need for additional instrument substitutions. Werecognize the value of consistency in measurement across studies, as inconsistentoutcomes render findings across studies more difficult to reconcile.

The presentation of two batteries allows researchers to choose cognitive outcomemeasures according to the time allowances and resources of each study, as well asthe questions being addressed. While consistency across studies is ideal, werecognize that some scientific inquiries or sample populations will require themodification of these tests batteries. For instance, while the Digit-Symbolsubstitution test (WAIS-III) is recommended as a measure of speeded sequencing,

the similar Symbol-Digit Modalities Test might be substituted in samples wherepopulations have major motor deficits (e.g., hemiparesis) as an oral version exists.

The instruments below have been selected due to extensive and favorablereliability, construct validity, and predictive utility, and/or history of use in the targetpatient population.

These recommended batteries are aimed to optimize sensitivity to executive andprocessing speed deficits, while tapping the cognitive domains of memory,language, and visual-spatial functions as well.

The Outcomes and End Points Subgroups recommended measures for Emotionaland Cognitive Status are listed below. The subsequent pages describe theseinstruments in further detail.

Short Battery (Core Instruments):

o Center for Epidemiologic Studies Depression Scale (CES-D)*

o The Montreal Cognitive Assessment (MoCA)

o Trail Making Test (A&B)

Long Battery (Supplemental Instruments):

o Digit Symbol subtest of the Wechsler Adult Intelligence Scale III

o Symbol Search subtest of the Wechsler Adult Intelligence Scale III

o Stroop Test

o Hopkins Verbal Learning Test Revised

o Rey-Osterrieth Complex Figure Copy and Delay

o Boston Naming Test (BNT) 30-item version

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Recommendations

o Information Questionnaire for Cognitive Decline in the Elderly

(IQCODE)*

o Neuropsychiatric Inventory (NPI) Questionnaire

Additional instrument (Supplemental Instrument):

o Telephone Interview for Cognitive Status (TICS)

1Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, PowersWJ, DeCarli C, Merino JG, Kalaria RN, Vinters HV, Holtzman DM, Rosenberg GA,Wallin A, Dichgans M, Marler JR, Leblanc GG. National Institute of NeurologicalDisorders and Stroke-Canadian Stroke Network vascular cognitive impairmentharmonization standards. Stroke 2006;37(9):2220-2241.

* Information about the instrument is included in a separate CRF Module and is

therefore not included in this document.

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Recommendations

The Montreal Cognitive Assessment (MoCA)

Core/Primary Instrument also recommended by the Stroke Presentation Subgroup

PurposeThe MoCA screens patients who present with mild cognitive complaints and normal

mini-mental state examination (MMSE) scores for mild cognitive impairment (MCI).2

While the MMSE is a ubiquitous cognitive screening instrument, its relative

insensitivity to executive dysfunction and the focal cognitive deficits3 that can often

been seen in stroke render it suboptimal for cerebrovascular populations. In fact, a

recent study4 demonstrated the underestimation of cognitive deficits by the MMSE

versus the MoCA in individuals with TIAs and stroke in a large population based

study.

OverviewThe MoCA is a screening test of cognition with favorable psychometric properties.2

It screens eight domains: Visuospatial/executive, Naming, Memory, Attention,

Language, Abstraction, Delayed recall, and Orientation.

Time

The assessment takes approximately 10 minutes.

Scoring

The total possible score is 30 points (total for each domain: Visuospatial/executive

5, Naming 3, Memory None, Attention 6, Language 3, Abstraction 2,

Delayed recall 5, Orientation 6). A normal score is greater than or equal to 26

points. The suggested cut-off score [MCI or Alzheimer's disease (AD)] is any score

less than 26. One point is added for an individual who has 12 years or fewer of

formal education; however the total possible score remains the same. Note that

additional studies of optimizing cut-points in different populations are currently

underway.

Psychometric Properties

There are strong validation studies emerging across patient populations (e.g.,

cerebrovascular, MCI/AD, Parkinsons disease).1,5,6

Other Important Notes

Available in various languages (currently 31 total).

Raters using this at admission or discharge should develop a standard methodology

and scoring instructions for use in hospital setting.

Copyright Information

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Recommendations

Universities/ Foundations/ Health Professionals/ Hospitals/Clinics/ Public Health

Institutes: MoCA may be used, reproduced, and distributed, WITH prior written

permission. The test should be made available free of charge.

Commercial Entity/ Pharma sponsored research: MoCA may be used, reproduced,

and distributed, WITH prior written permission and Licensing Agreement. The test

should be made available free of charge.

For additional information, please visit website: http://www.mocatest.org/.

References1Luis C., Keegan A, & Mullan, M (2009). Cross validation of the Montreal cognitive

assessment in community dwelling older adults residing in the southeastern US.

International Journal of Geriatric Psychiatry, 24: 197-201.

2Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I,Cummings JL, Chertkow H (2005). The Montreal Cognitive Assessment, MoCA: a

brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 53(4): 695-699.

3Naugle, R., & Kawczak, K. (1989). Limitations of the Mini-Mental State Examination.

Cleveland Clinic Journal of Medicine, 56, 277-281.

4Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. (2010).

Underestimation of cognitive impairment by mini-mental state examination versus

the montreal cognitive assessment in patients with transient ischemic attack and

stroke: a population-based study. Stroke. 2010 Jun;41(6):1290-3. Epub 2010 Apr 8.

5Popovic, IM, Seric, V, & Demarin, V. (2007). MCI in symptomatic and asymptomatic

cerebrovascular disease. J Neurol Sci, 257, 185-193.

6Zadikoff, C., Fox, SH, Tang-Wai, DF, Thomsen, T., de Bie, RM, Wadia, P, Miyasaki, J.,

Duff-Canning, S., Lang, AE, & Marras, C. (2008). A comparison of the MMSE to the

MoCA in identifying cognitive deficits in PD. Mov Disord, 23, 297-299.

Stroke Version 1.0
http://www.mocatest.org/http://www.mocatest.org/


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Recommendations

Trail Making Test (A&B)

Core/Primary Instrument

PurposeThe Trail Making Test is a measure of executive ability. The Trail Making Test is one

of the most sensitive measures of cognition. For instance, it has been shown to

discriminate between those with presymptomatic Alzheimer's disease (AD) and

those who remain without dementia over time.1

Overview

The first part of this test, Trails A, requires the subject to rapidly sequence numbers

from 1 through 25, with the score being the time to complete the task. The second

part, Trails B, is a more difficult cognitive flexibility task requiring the subject to

follow a sequential pattern while shifting cognitive sets, sequencing from 1 to 13while switching between numbers and letters (i.e., 1-A-2-B, etc), with the score

being the time to complete the task. The measure of interest is Trails B. Its utility

and psychometric properties are so well accepted that it is one of the few measures

that it is used across neurologic and psychiatric clinical and research patient

populations.5

Time

The assessment takes approximately 2-4 minutes for each portion.

Scoring

Scoring of A and B are reported as the number of seconds required to complete the

task. Higher scores indicate greater impairment. Performance varies by age and

education, and thus normative standards are used to classify patient performance.3

Errors affect the patients score only in that the correction of errors is included in

the completion time for the task. If a patient has not completed both parts after

five minutes, it is unnecessary to continue the test.


Interrater reliability has been found to be high for both A and B. 2

Other Important NotesThe TMT is ubiquitous in clinical and research practice, across patient populations.4


PAR, Inc. offers the Comprehensive Trail-Making Test (CTMT), a standardized set of

five visual search and sequencing tasks. For additional information, visit:

http://www4.parinc.com/Products/

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Recommendations

SpecialtyAutomated Systems Corporation offers an online version of the TrailMaking Test. For more information, visit: http://www.trailmakingtest.com/.

References1Chen P, Ratcliff G, Belle S, al. e. Cognitive test that best discriminate between

presympomatic AD and those who remain nondemented. Neurology 2000;55:1847-

1853.

2Fals-Stewart W. An Interrater Reliability Study of the Trail Making Test (Parts A and

B). Perceptual and Motor Skills, 1992, 74: 39-42.

3Heaton, R. K., Grant, I., & Matthews, C. G. (1991). Comprehensive norms for an

expanded HalsteadReitan Battery: Demographic corrections, research findings,and clinical applications. Odessa, FL: Psychological Assessment Resources.

4Lezak, MD., Howieson, DB, & Loring, DW (2004). Orientation and Attention. In:

Neuropsychological Assessment: Fourth Edition. (pg. 372-374). Oxford University

Press, NY: NY.

5Reitan RM. (1992). Trail making test. Tucson, AZ: Reitan Neuropsychology

Laboratory.

Stroke Version 1.0
http://www.trailmakingtest.com/http://www.trailmakingtest.com/


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Recommendations

Digit Symbol subtest of the Wechsler Adult Intelligence Scale III

Supplemental Instrument

Purpose

This test has been shown to predict group membership defined by processing speed

deficits, such as brain-injured versus control samples1 and has been used as a

sensitive outcome in studies identifying predictors of longitudinal decline in elders2.

Overview

The digit-symbol subtest measures the time to recode symbol and digit items. The

test requires elements of attention, visuoperceptual processing, working memory,

and psychomotor speed.

Time

Assessment takes a few minutes to complete

Scoring

The score is the number correctly coded from 0-133 in 120 seconds.


The test demonstrates strong reliability and validity coefficients .3


N/A


Copyright belongs to Pearson Education Inc. For additional information and to order

test material, visit: http://www.pearsonassessments.com/

References1DeMonte, VE, Geffen, GM, May, CR, & MacFarland, K. (2009). Improved sensitivity

of the rapid screen of mild traumatic brain injury. J Clin Exp Neuropsychology, 6, 1-

11.

2Knopman, DS, Mosley, TH, Catellier, DJ, Coker, LH, Atherosclerosis risk incommunities study brain MRI study (2009). Fourteen-year longitudinal study of

vascular risk factors, APOE genotype, and cognition: the ARIC MRI study.

Alzheimers & Dementia: the Journal of the Alzheimers Association, 5, 207-214.

3Wechsler D. (1997). Wechsler adult intelligence scale-III. New York: Psychological

Corporation.

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Recommendations

Symbol Search subtest of the Wechsler Adult Intelligence Scale III


PurposeThe symbol-search subtest of the WAIS III is an indicator of processing speed and

visual perception.

Overview

The symbol-search subtest requires rapid identification of targets. Specifically, for

each item the subject must search a series of five figures to see if either of two

targets occur, and mark yes or no for each item. Recent fMRI findings have shown

greater activity in the left dorsolateral prefrontal cortices associated with slower

symbol search performance.1 This subtest and the Digit-Symbol subtest together

comprise the Processing Speed Index of the WAIS-III.

Scoring

The score is the number correct in 120 seconds from 0-60.

Time

Assessment takes approximately 3 minutes.


The subtest has shown validity in studies of adults with various neurological

disorders.2


N/A


Copyright belongs to Pearson Education Inc. For additional information and to order

test material, visit: http://www.pearsonassessments.com/

References1Sweet LH, Paskavitz JF, OConnor MJ, Browndyke JN, Wellen JW, Cohen RA (2005).

FMRI correlates of the WAIS-III Symbol Search subtest. J of Int NeuropsychologicalSociety, 11, 471-6.

2Wechsler D. (1997). Wechsler adult intelligence scale-III. New York: Psychological

Corporation.

Stroke Version 1.0
http://www.pearsonassessments.com/%20http://www.pearsonassessments.com/%20


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Recommendations

Stroop Test


PurposeThe Stroop test is a measure of the ability to inhibit overlearned responses in the

face of conflicting information.

Overview

The Stroop test involves three trials. First, in the WORD trial, the subject reads

words of color names (e.g., red, blue) printed in black ink. Second, in the COLOR

trial, the subject identifies colors (e.g., XXXX printed in red or blue). Finally, in the

COLOR-WORD response inhibition trial, the subject must name the color in which a

word is presented, while ignoring the printed word. Thus, incongruence between the

words color and identity (e.g., the word blue presented in red) requires inhibitionand response selection.1 In a recent study of white-matter integrity, Stroop scores

demonstrated that microstructual white matter abnormalities of frontostriatal-limbic

networks are associated with executive deficits.3

Time

Assessment takes approximately 5 minutes.

Scoring

Scoring is based on the number of correct responses within a specified time.


In a recent study, microstructual white matter abnormalities of frontostriatal-limbic

networks were associated with Stroop performance in depressed patients. 3 A large

imaging study of community-dwelling elders found that Stroop performance was

related to number of silent lacunar infarcts, larger WMLs, and more prominent

cerebral atrophy.2


N/A

Copyright InformationMultiple versions of the Stroop test are available. To date, one version of the tests

has not been shown to be clearly superior to others.

A commonly used version is the Delis-Kaplan Executive Function System (D-KEFS)

Color-Word Interference Test (CWIT). The CWIT consists of the three traditional

Stroop trials (color naming, color name reading, interference) as well as a fourth

trial in which the subject switches back and forth between naming the dissonant ink

colors and reading the conflicting color names. The stimulus booklet and forms are

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Recommendations

copyrighted and included as part of the D-KEFS test kit, but can be purchased

separately from the test publisher (www.pearsonassess.com).

References1Golden & Greshwater (2002). The Stroop Color and Word Test: A Manual for Clinical

and Experimental Uses. Wood Dale, IL: Stoelting Co.

2Koga H, Takashima Y, Murakawa R, Uchino A, Yuzuriha T, Yao H. (2009). Cognitive

consequences of multiple lacunes and leukoaraiosis as vascular cognitive

impairment in community-dwelling elderly individuals. J Stroke Cerebrovasc Dis.

2009 Jan;18(1):32-7.3Murphy CF, Gunning-Dixon FM, Hoptman MJ, Lim KO, Ardekani B, Shields JK, Hrabe

J, Kanellopoulos D, Shanmugham BR, Alexopoulos GS (2007). Biological Psychiatry,61, 1007-10

Stroke Version 1.0
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Recommendations

Hopkins Verbal Learning Test Revised


PurposeTHE HVLT-R offers a brief assessment of verbal learning and memory (recognitionand recall) for individuals 16 years and older. It is easy to administer and score andis well-tolerated even by significantly impaired individuals.1

Overview

The HVLT-R requires recall of a series of 12 words over three learning trials, free

recall after a delay, and a recognition trial.

Time

The assessment takes approximately 5-10 minutes with a 25-minute delay to

complete and 2 minutes to score.

Scoring

Raw scores are derived for Total Recall, Delayed Recall, Retention (% retained), and

a Recognition Discrimination Index


The HVLT-R correlated most strongly with other tests of verbal memory and

relatively weakly with a test of general intelligence.4 The construct validity of the

HVLT-R has been shown relative to other standard list learning tasks, 3 and it is

sensitive to dementia.2

The HVLT-R has generally modest-to-low one-year test-retest stability for several key HVLT-R component process variables.5


N/A


Copyright belongs to PAR, Inc. For additional information and to order test

materials, visit: http://www4.parinc.com/Products/

References1Brandt, J. & Benedict, R. (2001). Hopkins Verbal Learning Test-Revised: Professional

Manual. PAR: Florida.

2Hogervorst, E, Combrinck, M, Lapuerta, P et al (2002). The HVLT and screening for

dementia. Dementia and Geriatric Cognitive Disorder, 13, 13-20.

3Lacritz, LH & Cullum, CM (1998). The HVLT and CVLT: A preliminary compassion.

Archives of Clinical Neuropsychology, 13, 623-628.

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4Shapiro AM, Benedict RH, Schretlen D, Brandt J (1999). The Clinical

Neuropsychologist, 13, 348-358.

5Woods, SP (2005). Test-Retest Reliability of Component Process Variables Within

the Hopkins Verbal Learning Test-Revised. Assessment, 12, 96-100.

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Recommendations

Rey-Osterrieth Complex Figure Copy and Delay


PurposeThe Rey-Osterrieth Complex Figure (ROCF) test requires the subject to copy a

complex geometric figure, providing an index of design reproduction/graphic ability.

A recall trial then taps visual memory for the stimuli.1

Overview

The ROCF is a widely used neuropsychological test for the evaluation of visuospatial

constructional ability (Copy trial) and visual memory (Immediate Recall, Delayed

Recall, and Recognition trials). It consists of three test conditions: Copy, Immediate

Recall and Delayed Recall.2

Time

The assessment takes approximately 45 minutes, including a 30-minute delay interval (timed).

Scoring

Drawings are scored based on a 36-point scoring system. The same scoring criteria

apply to all three drawing trials. Each of the 18 scoring units is scored based on

accuracy and placement criteria. Unit scores range from two (accurately drawn,

correctly placed) to zero (inaccurately drawn, incorrectly placed, unrecognizable,

omitted).2


The test has been extensively validated across populations and has well established

normative standards.1 Intercorrelations between the ROCF and other measures, in

samples of both normal and brain-damaged subjects, indicate convergent and

discriminant validity. It reliably discriminates among brain-damaged, psychiatric,

and normal subjects. In addition, the Recognition trial provides incremental

diagnostic power compared to using recall trials alone.2


N/A


Copyright belongs to PAR, Inc. For additional information and test materials, visit:

http://www4.parinc.com/Products/

References1Lezak M, Howieson DB, Loring DW, Hannay HJ, Fischer JS (2004).

Neuropsychological Assessment. Oxford University Press.

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Recommendations

2Meyers J, Meyers K (1995). Rey Complex Figure Test and Recognition Trial:

Professional Manual. PAR: Florida.

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Recommendations

Controlled Oral Word Association Test (COWAT) (CFL/PRW)


PurposeThe COWAT detects changes in word association fluency often found in various

disorders.

Overview

This lexical fluency test requires the participant to produce as many words as

possible that start with a specified letter, within a 60 second interval. 1 Studies have

shown that deficits in verbal fluency often localize to frontal structures and

pathways, and are also associated with progressive dementias.2,4

TimeThe assessment time take approximately 4 minutes.

Scoring

Patients are given three letters, one at a time, and asked to generate a list of words

that begin with the specified letter (CFL or PRW).


The COWAT has high interrater reliability (.99).3


Higher education level is associated with better performance on COWAT. There is

little evidence of gender differences on COWAT.


Copyright belongs to PAR, Inc. as part of the Multilingual Aphasia Examination. For

test materials, go to: http://www4.parinc.com/Products/

References1Benton, A., & Hamsher, K (1989). Multilingual Aphasia Examination. Iowa City: AJA

Associates.

2Micelli, G., Caltagirone, C., Gainotti, G., et al (1981). Neuropsycholgical correlates

of localized cerebral lesions in nonaphasic brain-damaged patients. J of Clin

Neuropsychology, 3, 53-63.

3Ross TP. The reliability of cluster and switch scores for the Controlled Oral Word

Association Test. Arch Clin Neuropsychol 2003; 18: 153-64.

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4Troyer, AK, Moscovitch, M, Winocur, G et al (1998). Clustering and switching on

verbal fluency tests in Alzheimers and Parkinsons disease. J of the Intl

Neuropsychological Soc, 4, 137-143.

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Recommendations

Boston Naming Test (BNT) 30-item version


PurposeThe 30-item version of the BNT was designed to differentiate between Alzheimers

disease (AD) and normal subjects. This version is useful for repeated assessments

of a naming task, as well as in situations where administration of the complete BNT

is not practical.2

Overview

The BNT and its short forms are tasks of visual confrontation naming, sensitive to

deficits in semantic retrieval. Norms for this 30-item version were developed using

a registry including normal controls, mild cognitive impairment (MCI), and AD.1

Items have been rank ordered in terms of their ability to be named, which isthought to be correlated with their frequency.

Time


Scoring

Patients have 20 seconds to respond to each item. Each item is scored as correct,

correct with semantic cues, or correct with phonemic cues. The total score is the

number correct spontaneously or with semantic cues.


Interjudge and intrajudge reliability were found to be high, average of 89.1% and

97.6% respectively. Overall reliability using a matrix agreement system adjusting

for chance was 91.2%.3


Spanish versions of the BNT are available.4,5


The BNT is available from the Psychological Assessment Resources (PAR), 16130

North Florida Avenue, Lutz, FL 33549. For additional information, please visit:http://www4.parinc.com/Products/

References1Jefferson, AL, Wong, S., Gracer, TS, Ozonoff, A, Green, RC, & Stern RA. (2007).

Geriatric performance on an abbreviated version of the Boston naming test. Appl

Neuropsychol, 14, 215-223.

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2Mack WJ, Freed DM, Williams BW, Henderson VW (1992). Boston Naming Test:

Shortened versions for use in Alzheimers disease. J Gerontol, 47(3): 154-158.

3Nicholas LE, Brookshire RH, MacLennan DL, Schumacher JG, Porrazzo SA (1988).The Boston Naming Test: Revised Administration and Scoring Procedures and

Normative Information for Non-Brain-Damaged Adults. Clinical Aphasiology, 18:

103-115.4Pea-Casanova, J, Quinones-Ubeda, S, Gramunt-Fombuena, N, Aguilar, M, Casas, L,

Molinuevo, JL, et al. Spanish Multicenter Normative Studies (NEURONORMA Project):

norms for Boston naming test and token test. Arch Clin Neuropsychol. 2009; 24(4):

343-354.

5Ponton, MO, Satz, P, Herrera, L, Ortiz, F, Urrutia, CP, Young, R, et al. Normative data

stratified by age and education for the Neuropsychological Screening Battery forHispanics (NeSBHIS): Initial report. Journal of the International Neuropsychological

Society. 1996; 2(2): 96-104.

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Neuropsychiatric Inventory (NPI) Questionnaire


Purpose

The NPI-Q is used to measure 12 categories of behavioral disturbance, in particular:

Delusions, Hallucinations, Anxiety, Depression/Dysphoria, Agitation/Aggression,

Elation/Euphoria, Disinhibition, Irritability/Lability, Apathy/Indifference, Motor

Disturbance, Nighttime Behavior Problems, and Problems with Appetite/Eating. The

questionnaire is completed by a caregiver and asks whether the patient exhibits

each of the behaviors.2

Overview

The NPI Questionnaire is a validated caregiver completed questionnaire derivedfrom the original NPI. The questionnaire taps behavioral symptoms commonly

observed post-stroke (e.g., disinhibition, apathy, irritability).1

Time


Scoring

The administrator ranks the severity of each behavior exhibited on a scale of 1 to 3,

with 3 being the most severe. The total severity score is the sum of the severity

scores obtained for each behavioral category. Additionally, the administrator ranks

the patients level of distress from each behavior, on a scale of 1 to 5, with 5

indicating the most severe level of distress. The total distress score is the sum of

the distress scores obtained for each behavioral category.2


Test-retest reliabilityof the NPI-Q is acceptable. The NPI-Qprovides a brief, reliable,

informant-based assessment of neuropsychiatric symptoms and associated

caregiver distress that may be suitablefor use in general clinical practice.1


N/A


Copyright belongs to Jeffrey L. Cummings, MD. For additional information and test

materials, visit: http://www.mapi-trust.org/services/questionnairelicensing/ and

http://npitest.net/index.html

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References1Kaufer, DI, Cummings, JL, Ketchel, P, Smith, V, MacMillan, A, Shelley, T, Lopez, OL,

& DeKosky, ST. (2000). Validation of the NPI-Q, a brief clinical form of the

neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci, 12, 233-239.

2OHara R, Mumenthaler MS, Davies H, Cassidy EL, Buffum M, Namburi S, Shakoori

R, Danielsen CE, Tsui P, Noda A, Kraemer HC, Sheikh JI (2002). Cognitive status and

behavioral problems in older hospitalized patients. Annals of General Hospital

Psychiatry, 1.

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Recommendations

Telephone Interview for Cognitive Status (TICS)


Purpose

The Telephone Interview for Cognitive Status (TICS) is a brief, standardized test of

cognitive functioning that was developed for use in situations where in-person

cognitive screening is impractical or inefficient (e.g., large-scale population

screening, epidemiological surveys, with patients who are unable to appear in

person for clinical follow-up).1 It is also helpful in the diagnosis of documenting

progressive impairment, and might also identify incident disease in research

populations.3

OverviewThe TICS is designed to be administered using the telephone, however, it also may

be administered face-to-face. The TICS is particularly useful for examining visually

impaired individuals and individuals who are unable to read or write, since it does

not require vision.

The TICS is very brief and tests many of the basic cognitive functions affected by

dementia, consisting of an 11-items, that assess a variety of cognitive domains

affected by dementing disorders, including orientation to time and place, receptive

and expressive language functions, immediate verbal memory, calculation, and

verbal abstraction. It successfully differentiates carefully diagnosed Alzheimers

disease patients from healthy spouse controls and demonstrates high test-retestreliability in these populations.2

TimeThe test usually takes less than 10 minutes to administer and score.

ScoringThe individual item scores are summed to obtain the TICS Total score, ranging from0 -41.

Psychometric PropertiesThe TICS has a high test-retest reliability and excellent sensitivity and specificity for

the detection of cognitive impairment. Among elderly populations, TICS scoresapproximate a normal distribution and are not subject to the ceiling effects thatlimit the usefulness of many mental status examinations.1

Other Important NotesThe TICS has a modified version, TIC-m, which eliminates items that are difficult toverify in epidemiological study, and also included a delayed recall procedure in anattempt to increase sensitivity.2

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Recommendations

Before administering the telephone interview, the examiner must speak with

someone at the same location (e.g., family member, caregiver) who will serve as a

proctor to ensure that the environment is appropriate for testing and that theexaminee is able to hear spoken language at a spoken volume. All examinee

responses are recorded verbatim.1


The TICS is available from the Psychological Assessment Resources (PAR). For

additional information, please visit: http://www4.parinc.com/Products/

References1 Brandt J. (2010). Telephone Interview for Cognitive Status (TICS). PAR.

http://www4.parinc.com/Products/Product.aspx?ProductID=TICS

2 Welsh KA, Breitner JCS, Magruder-Habib KM. (1993). Detection of dementia in the

elderly using telephone screening of cognitive status. Neuropsychiatry

Neuropsychol Behav Neurol. 6:103-110.

3 Plassman BL, Newman TT, Welsh KA, Helms M, Breitner JCS. (1994). Properties of

the telephone Interview for Cognitive Status: application in epidemiological and

longitudinal studies. Neuropsychiatry Neuropsychol Behav Neurol. 7:235-241
http://www4.parinc.com/Products/http://www4.parinc.com/Products/Product.aspx?ProductID=TICShttp://www4.parinc.com/Products/http://www4.parinc.com/Products/Product.aspx?ProductID=TICS

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Additional Measures Recommended Emotional Cognitive Status

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