The dementia cognitive fluctuation scale, a new psychometric test for clinicians to identify cognitive fluctuations in people with dementia.

Lee, David R; McKeith, Ian; Mosimann, Urs Peter; Ghosh-Nodial, Arunima; Grayson, Louise; Wilson, Barbara; Thomas, Alan J (2014). The dementia cognitive fluctuation scale, a new psychometric test for clinicians to identify cognitive fluctuations in people with dementia. American journal of geriatric psychiatry, 22(9), pp. 926-935. Elsevier 10.1016/j.jagp.2013.01.072

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OBJECTIVES

Cognitive fluctuation (CF) is a common feature of dementia and a core diagnostic symptom for dementia with Lewy bodies (DLB). CF remains difficult to accurately and reliably detect clinically. This study aimed to develop a psychometric test that could be used by clinicians to facilitate the identification of CF and improve the recognition and diagnosis of DLB and Parkinson disease, and to improve differential diagnosis of other dementias.

METHODS

We compiled a 17-item psychometric test for identifying CF and applied this measure in a cross-sectional design. Participants were recruited from the North East of England, and assessments were made in individuals' homes. We recruited people with four subtypes of dementia and a healthy comparison group, and all subjects were administered this pilot scale together with other standard ratings. The psychometric properties of the scale were examined with exploratory factor analysis. We also examined the ability of individual items to identify CF to discriminate between dementia subtypes. The sensitivity and specificity of discriminating items were explored along with validity and reliability analyses.

RESULTS

Participants comprised 32 comparison subjects, 30 people with Alzheimer disease, 30 with vascular dementia, 29 with DLB, and 32 with dementia associated with Parkinson disease. Four items significantly discriminated between dementia groups and showed good levels of sensitivity (range: 78.6%-80.3%) and specificity (range: 73.9%-79.3%). The scale had very good levels of test-retest (Cronbach's alpha: 0.82) and interrater (0.81) reliabilities. The four items loaded onto three different factors. These items were: 1) marked differences in functioning during the daytime; 2) daytime somnolence; 3) daytime drowsiness; and 4) altered levels of consciousness during the day.

CONCLUSIONS

We identified four items that provide valid, sensitive, and specific questions for reliably identifying CF and distinguishing the Lewy body dementias from other major causes of dementia (Alzheimer disease and vascular dementia).

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy 04 Faculty of Medicine > University Psychiatric Services > University Hospital of Geriatric Psychiatry and Psychotherapy
UniBE Contributor:	Mosimann, Urs Peter
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1064-7481
Publisher:	Elsevier
Language:	English
Submitter:	Pascal Wurtz
Date Deposited:	03 Nov 2014 12:02
Last Modified:	05 Dec 2022 14:37
Publisher DOI:	10.1016/j.jagp.2013.01.072
PubMed ID:	24332982
Uncontrolled Keywords:	Cognitive fluctuation, Lewy body, dementia, psychometric
URI:	https://boris.unibe.ch/id/eprint/59783