Greater than the sum of its parts: δ improves upon a battery's diagnostic performance

Donald R. Royall, Teruyuki Matsuoka, Raymond F. Palmer, Yuka Kato, Shogo Taniguchi, Mayu Ogawa, Hiroshi Fujimoto, Aiko Okamura, Keisuke Shibata, Kaeko Nakamura, Shutaro Nakaaki, Hiroyuki Koumi, Masaru Mimura, Kenji Fukui, Jin Narumoto

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: "δ", a latent variable constructed from batteries that contain both cognitive and functional status measures, can accurately diagnose dementia relative to expert clinicians. The minimal assessment needed is unknown. Methods: We validated 2 δ homologs in a convenience sample of elderly Japanese persons with normal cognition (NC), mild cognitive impairment (MCI), and dementia (n = 176). The latent δ homolog "d" (for dementia) was constructed from Instrumental Activities of Daily Living (IADL) and Japanese translationsof the Executive Clock-Drawing Task (CLOX), Frontal Assessment Battery (FAB), and Executive Interview (EXIT25). The latent delta homolog "d3" was constructed from a restricted set of d's factor loadings. Results: d and d3 were highly intercorrelated (r = .97) and strongly related to both IADL and dementia severity, as rated blindly by the Clinical Dementia Rating Scale (CDR). d was more strongly related to IADL and CDR than any of its indicators. In multivariate regression, d explained more variance in CDR scores than all of its indicators combined. d's areas under the receiver operating characteristic curve (AUC) were 0.95 for the discrimination between Alzheimer's disease (AD) vs. NC, 0.84 for AD vs. MCI and 0.81 for NC vs. MCI. d3's AUC's were statistically indiscriminable. These AUC's are higher than any of d's indicators, as reported recently by Matsuoka et al. (2014), as well as the Mini-Mental State Examination (MMSE), which had been made available by Matsuoka et al. to the CDR raters. Conclusions: Latent variables can improve upon a battery's diagnostic performance and offer the potential for accurate dementia case-finding after a minimal bedside assessment.

Original languageEnglish
Pages (from-to)683-692
Number of pages10
JournalNeuropsychology
Volume29
Issue number5
Publication statusPublished - 2015 Sep 1
Externally publishedYes

Fingerprint

Dementia
Activities of Daily Living
Cognition
Area Under Curve
Alzheimer Disease
Battery
Diagnostics
ROC Curve
Interviews
Rating Scales
Cognitive Dysfunction
Mild Cognitive Impairment

Keywords

  • CLOX
  • Dementia
  • Executive function
  • ExIT25
  • Instrumental activities of daily living

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Arts and Humanities (miscellaneous)

Cite this

Royall, D. R., Matsuoka, T., Palmer, R. F., Kato, Y., Taniguchi, S., Ogawa, M., ... Narumoto, J. (2015). Greater than the sum of its parts: δ improves upon a battery's diagnostic performance. Neuropsychology, 29(5), 683-692.

Greater than the sum of its parts : δ improves upon a battery's diagnostic performance. / Royall, Donald R.; Matsuoka, Teruyuki; Palmer, Raymond F.; Kato, Yuka; Taniguchi, Shogo; Ogawa, Mayu; Fujimoto, Hiroshi; Okamura, Aiko; Shibata, Keisuke; Nakamura, Kaeko; Nakaaki, Shutaro; Koumi, Hiroyuki; Mimura, Masaru; Fukui, Kenji; Narumoto, Jin.

In: Neuropsychology, Vol. 29, No. 5, 01.09.2015, p. 683-692.

Research output: Contribution to journalArticle

Royall, DR, Matsuoka, T, Palmer, RF, Kato, Y, Taniguchi, S, Ogawa, M, Fujimoto, H, Okamura, A, Shibata, K, Nakamura, K, Nakaaki, S, Koumi, H, Mimura, M, Fukui, K & Narumoto, J 2015, 'Greater than the sum of its parts: δ improves upon a battery's diagnostic performance', Neuropsychology, vol. 29, no. 5, pp. 683-692.
Royall DR, Matsuoka T, Palmer RF, Kato Y, Taniguchi S, Ogawa M et al. Greater than the sum of its parts: δ improves upon a battery's diagnostic performance. Neuropsychology. 2015 Sep 1;29(5):683-692.
Royall, Donald R. ; Matsuoka, Teruyuki ; Palmer, Raymond F. ; Kato, Yuka ; Taniguchi, Shogo ; Ogawa, Mayu ; Fujimoto, Hiroshi ; Okamura, Aiko ; Shibata, Keisuke ; Nakamura, Kaeko ; Nakaaki, Shutaro ; Koumi, Hiroyuki ; Mimura, Masaru ; Fukui, Kenji ; Narumoto, Jin. / Greater than the sum of its parts : δ improves upon a battery's diagnostic performance. In: Neuropsychology. 2015 ; Vol. 29, No. 5. pp. 683-692.
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AU - Royall, Donald R.

AU - Matsuoka, Teruyuki

AU - Palmer, Raymond F.

AU - Kato, Yuka

AU - Taniguchi, Shogo

AU - Ogawa, Mayu

AU - Fujimoto, Hiroshi

AU - Okamura, Aiko

AU - Shibata, Keisuke

AU - Nakamura, Kaeko

AU - Nakaaki, Shutaro

AU - Koumi, Hiroyuki

AU - Mimura, Masaru

AU - Fukui, Kenji

AU - Narumoto, Jin

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N2 - Objective: "δ", a latent variable constructed from batteries that contain both cognitive and functional status measures, can accurately diagnose dementia relative to expert clinicians. The minimal assessment needed is unknown. Methods: We validated 2 δ homologs in a convenience sample of elderly Japanese persons with normal cognition (NC), mild cognitive impairment (MCI), and dementia (n = 176). The latent δ homolog "d" (for dementia) was constructed from Instrumental Activities of Daily Living (IADL) and Japanese translationsof the Executive Clock-Drawing Task (CLOX), Frontal Assessment Battery (FAB), and Executive Interview (EXIT25). The latent delta homolog "d3" was constructed from a restricted set of d's factor loadings. Results: d and d3 were highly intercorrelated (r = .97) and strongly related to both IADL and dementia severity, as rated blindly by the Clinical Dementia Rating Scale (CDR). d was more strongly related to IADL and CDR than any of its indicators. In multivariate regression, d explained more variance in CDR scores than all of its indicators combined. d's areas under the receiver operating characteristic curve (AUC) were 0.95 for the discrimination between Alzheimer's disease (AD) vs. NC, 0.84 for AD vs. MCI and 0.81 for NC vs. MCI. d3's AUC's were statistically indiscriminable. These AUC's are higher than any of d's indicators, as reported recently by Matsuoka et al. (2014), as well as the Mini-Mental State Examination (MMSE), which had been made available by Matsuoka et al. to the CDR raters. Conclusions: Latent variables can improve upon a battery's diagnostic performance and offer the potential for accurate dementia case-finding after a minimal bedside assessment.

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