Screening for Dementia: An examination of subscale relative importance

Abstract

Approximately 13 percent of the American population are 65 years of age or older (Vincent & Velkof, 2010). Of these 48 million older adults, roughly 5.3 million have received a clinical diagnosis of Alzheimer’s disease (AD) (Alzheimer’s Association, 2017). As the awareness of AD continues to heighten, so does the push for increased cognitive screening to identify signs of abnormal aging. However, important considerations pertaining to scale development or weighting procedures applied during the test development process remain unclear, as they are often not reported in testing manuals. The current study presents a statistically derived scoring algorithm for a brief screening measure of cognition, the Mattis Dementia Rating Scale 2 (DRS-2) in a sample of 113 older adults (55 Alzheimer’s disease dementia, 58 Mild Cognitive Impairment. Logit weights obtained from logistic regression analysis were utilized to re-weight the subscales of the DRS-2 to reflect the order of relative importance of the five DRS-2 subscales. Sensitivity and specificity rates of the original and logit-weighted DRS-2 scores were compared to examine the impact of weighting on DRS-2 classification accuracy. Results indicated an increase in sensitivity from 78% to 90% and a decrease in specificity utilizing the newly computed logit-weighted scores. These results highlight the importance of scale construction during the instrument development process, suggesting that weighting procedures directly affect measurement utility. Additional implications for future clinical practice and research are discussed

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