Journal Article

Diagnostic accuracy of the Brief Assessment of Impaired Cognition case‐finding instrument in a general practice setting and comparison with other widely used brief cognitive tests—a cross‐validation study

Nielsen, Ann, Waldorff, Frans B., Gerner, Sofie D., Jørgensen, Kasper, Waldemar, Gunhild, Nielsen, T. Rune, Oxbøll, Anne‐Britt

2024

Overview

Background and purpose The aim of this study was to examine the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) case‐finding instrument in a general practice (GP) setting and compare it with other widely used brief cognitive instruments. Methods Patients aged ≥70 years were prospectively recruited from 14 Danish GP clinics. Participants were classified as having either normal cognition (n = 154) or cognitive impairment (n = 101) based on neuropsychological test performance, reported instrumental activities of daily living, and concern regarding memory decline. Comparisons involved the Mini‐Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), the Mini‐Cog, the 6‐item Clock Drawing Test (CDT‐6) and the BASIC Questionnaire (BASIC‐Q). Results BASIC demonstrated good overall classification accuracy with an area under the receiver operating characteristic curve (AUC) of 0.88 (95% confidence interval [CI] 0.84–0.92), a sensitivity of 0.72 (95% CI 0.62–0.80) and a specificity of 0.86 (95% CI 0.79–0.91). Pairwise comparisons of the AUCs of BASIC, MMSE, MoCA and RUDAS produced non‐significant results, but BASIC had significantly higher classification accuracy than Mini‐Cog, BASIC‐Q and CDT‐6. Depending on the pretest probability of cognitive impairment, the positive predictive validity of BASIC varied from 0.83 to 0.36, and the negative predictive validity from 0.97 to 0.76. Conclusions BASIC demonstrated good discriminative validity in a GP setting. The classification accuracy of BASIC is equivalent to more complex, time‐consuming instruments, such as the MMSE, MoCA and RUDAS, and higher than very brief instruments, such as the CDT‐6, Mini‐Cog and BASIC‐Q.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Accuracy / Activities of daily living / Aged / Aged, 80 and over / Classification / Cognition / Cognition & reasoning / Cognitive ability / cognitive dysfunction / Cognitive Dysfunction - diagnosis / dementia / Dementia and Cognitive Disorders / Dementia disorders / Female / general practice / General Practice - standards / Humans / Impairment / Male / memory disorders / mental status and dementia tests / Mental Status and Dementia Tests - standards / Mental Status and Dementia Tests - statistics & numerical data / Neuropsychological Tests - standards / Original / Prospective Studies / Reproducibility of Results / Sensitivity and Specificity / Statistical analysis / Validity