PDF icon Download PDF
Open Access
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(10): 864-870
DOI: 10.1590/0004-282X-ANP-2020-0473
Article

Brief version of the CAMCOG for illiterate older adults with Alzheimer’s dementia

Versão breve do CAMCOG para idosos analfabetos com doença de Alzheimer
Juliana Francisca Cecato 
1   Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.
2   Universidade São Francisco, Departamento de Psicologia, Bragança Paulista SP, Brazil.
,
Everton Balduino 
1   Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.
,
José Eduardo Martinelli 
1   Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.
,
Ivan Aprahamian 
1   Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Group of Investigation on Multimorbidity and Mental Health in Aging, Jundiaí SP, Brazil.
› Author Affiliations
› Further Information
Also available ateRef
  Permissions and Reprints
Preview

Abstract

Background: The Cambridge Cognition Examination (CAMCOG) is one of the most used cognitive assessment batteries for older adults. Objective: To evaluate a brief version of the CAMCOG for illiterate older adults (CAMCOG-BILL) with Alzheimer’s dementia (AD) and healthy controls (CG). Methods: Cross-sectional case-control study with 246 illiterate older adults (AD [n=159] and CG [n=87], composed by healthy seniors without cognitive complaints) who never attended school or took reading or writing lessons. Diagnosis of AD was established based on the NIA-AA and DSM-5 criteria. All participants were assessed with the CAMCOG by a researcher blinded for diagnosis. To assess the consistency of the chosen CAMCOG-BILL sub-items, we performed a binary logistic regression analysis. Results: Both the CAMCOG and the CAMCOG-BILL had satisfactory psychometric properties. The area under the curve (AUC) was 0.932 (p<0.001) for the original version of CAMCOG and 0.936 for the CAMCOG-BILL. Using a cut-off score of ≥60 (CAMCOG) and ≥44 (CAMCOG-BILL), both instruments had the same sensitivity and specificity (89 and 96%, respectively). Conclusion: The CAMCOG-BILL may be a preferred tool because of the reduced test burden for this vulnerable subgroup of illiterate patients with dementia.

RESUMO

Antecedentes: O Cambridge Cognition Examination (CAMCOG) é uma das baterias de avaliação cognitiva mais usadas para idosos. Objetivos: Avaliar uma versão breve do CAMCOG para idosos analfabetos (CAMCOG-BILL) com demência de Alzheimer (DA) em comparação com controles saudáveis não demenciados (GC). Métodos: Estudo caso-controle transversal com 246 idosos analfabetos (AD [n=159] e GC [n=87], composto por idosos saudáveis sem queixas cognitivas) que nunca frequentaram a escola ou fizeram aulas de leitura ou redação. O diagnóstico de DA foi estabelecido pelos critérios NIA-AA e DSM-5. Todos os participantes foram avaliados por meio do CAMCOG por avaliador cego, para o diagnóstico dos grupos. Para avaliar a consistência dos subitens escolhidos do CAMCOG-BILL, realizou-se uma análise de regressão logística binária. Resultados: Tanto o CAMCOG quanto o CAMCOG-BILL apresentaram propriedades psicométricas satisfatórias. A área sob a curva (AUC) foi de 0,932 (p<0,001) para a versão original do CAMCOG e de 0,936 para o CAMCOG-BILL. Usando-se uma pontuação de corte de ≥60 (CAMCOG) e ≥44 (CAMCOG-BILL), ambos os instrumentos tiveram a mesma sensibilidade e especificidade (89 e 96%, respectivamente). Conclusão: O CAMCOG-BILL pode ser preferido para reduzir a sobrecarga do teste para esse subgrupo vulnerável de pacientes analfabetos com demência.

Keywords:

Alzheimer Disease - Education - Neuropsychological Tests - Aging

Palavras-chave:

Doença de Alzheimer - Educação - Testes Neuropsicológicos - Envelhecimento

Authors’ contributions:

JFC: designed, collected the data and wrote the manuscript; EB: wrote the manuscript; JEM: supervised the data collection; IA: designed the study, wrote and reviewed the manuscript.


Support:

Prof. Aprahamian received a level two national public grant from the National Council for Scientific and Technological Development (Ministry of Science, Technology, Innovation and Communications, Brazil).




Publication History

Received: 06 October 2020

Accepted: 12 January 2021

Article published online:
07 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Fritsch T, McClendon MJ, Smyth KA, Ogrocki PK. Effects of educational attainment and occupational status on cognitive and functional decline in persons with Alzheimer-type dementia. Int Psychogeriatr. 2002 Dec;14(4):347-63. https://doi.org/10.1017/s1041610202008554
  • 2 Lee WJ, Liang CK, Peng LN, Chiou ST, Chen LK. Protective factors against cognitive decline among community-dwelling middle-aged and older people in Taiwan: A 6-year national population-based study. Geriatr Gerontol Int. 2017 Apr;17 Suppl 1:20-7. https://doi.org/10.1111/ggi.13041
  • 3 Balduino E, Melo BAR, Sousa LSM, Martinelli JE, Cecato JF. The “Superagers” construct in clinical practice: neuropsychological assessment of illiterate and educated elderly. Int Psychogeriatr. 2019 Sep;32(2):191-8. https://doi.org/10.1017/S1041610219001364
  • 4 Kremen WS, Beck A, Elman JA, Gustavson DE, Reynolds CA, Tu XM, et al. Influence of young adult cognitive ability and additional education on later-life cognition. Proc Natl Acad Sci U S A. 2019 Feb;116(6):2021-6. https://doi.org/10.1073/pnas.1811537116
  • 5 Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug;396(10248):413-46. https://doi.org/10.1016/S0140-6736(20)30367-6
  • 6 Stern Y. Cognitive reserve. Neuropsychologia. 2009 Aug;47(10):2015-28. https://doi.org/10.1016/j.neuropsychologia.2009.03.004
  • 7 Julayanont P, Ruthirago D. The illiterate brain and the neuropsychological assessment: from the past knowledge to future new instruments. Appl Neuropsychol Adult. 2018 Mar-Apr;25(2):174-87. https://doi.org/10.1080/23279095.2016.1250211
  • 8 Barulli D, Stern Y. Efficiency, capacity, compensation, maintenance, plasticity: emerging concepts in cognitive reserve. Trends Cogn Sci. 2013 Oct;17(10):502-9. https://doi.org/10.1016/j.tics.2013.08.012
  • 9 Paradela EM, Lopes CS, Lourenço RA. Reliability of the Brazilian version of the Cambridge Cognitive Examination Revised CAMCOG-R. Arq Neuro-Psiquiatr. 2009 Jun;67(2B):439-44. https://doi.org/10.1590/S0004-282X2009000300013
  • 10 Paradela EM, Lourenço RA. Is the Cambridge Cognitive Examination - revised a good tool for detection of dementia in illiterate Brazilian older adults? Geriatr Gerontol Int. 2014 Oct;14(4):763-8. https://doi.org/10.1111/ggi.12161
  • 11 UNESCO – UIS (Unesco Institute for Statistics). Education metadata from UIS Statistical. 2019 [accessed on Jun 16, 2020]. Available at: http://data.uis.unesco.org.
  • 12 Columbia Center of Sustainable Investment. Emerging Market Global Players (EMGP). 2018 [accessed on Jun 16, 2020]. Available at: http://ccsi.columbia.edu/files/2013/10/EMGP.pdf
  • 13 Ardila A, Bertolucci PH, Braga LW, Castro-Caldas A, Judd T, Kosmidis MH et al. Illiteracy: the neuropsychology of cognition without reading. Arch Clin Neuropsychol. 2010 Dec;25(8):689-712. https://doi.org/10.1093/arclin/acq079
  • 14 Aprahamian I, Martinelli J, Cecato J, Izbicki R, Yassuda M. Can the CAMCOG be a good cognitive test for patients with Alzheimer’s disease with low levels of education? Int Psychogeriatr. 2011 Feb;23(1):96-101. https://doi.org/10.1017/S104161021000116X
  • 15 Nunes PV, Diniz BS, Radanovic M, Abreu ID, Borelli DT, Yassuda MS, et al. CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. Int J Geriatr Psychiatry. 2008 Nov;23(11):1127-33. https://doi.org/10.1002/gps.2038
  • 16 Aprahamian I, Diniz BS, Izbicki R, Radanovic M, Nunes PV, Forlenza OF. Optimizing the CAMCOG test in the screening for mild cognitive impairment and incipient dementia: saving time with relevant domains. Int J Geriatr Psychiatry. 2011 Apr;26(4):403-8. https://doi.org/10.1002/gps.2540
  • 17 McKhann G, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas C, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011 May;7(3):263-9. https://doi.org/10.1016/j.jalz.2011.03.005
  • 18 American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Association.; 2013.
  • 19 Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-1983;17(1):37-49. https://doi.org/10.1016/0022-3956(82)90033-4
  • 20 Roth M, Tym E, Mountjoy CQ, Huppert FA, Hendrie H, Verma S, Goddard R. CAMDEX. A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry. 1986 Dec;149:698-709. https://doi.org/10.1192/bjp.149.6.698
  • 21 Brucki S, Nitrini R, Caramelli P, Bertolucci P, Okamoto I. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuro-Psiquiatr. 2003 Sep;61(3-B):777-81. https://doi.org/10.1590/S0004-282X2003000500014
  • 22 Folstein MF, Folstein SE, McHugh P. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. https://doi.org/10.1016/0022-3956(75)90026-6
  • 23 Pfeffer RI, Kurosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982 May;37(3):323-9. https://doi.org/10.1093/geronj/37.3.323
  • 24 Chen A, Akinyemi RO, Hase Y, Firbank MJ, Ndunq’u MN, Foster V, et al. Frontal white matter hyperintensities, clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia. Brain. 2016 Jan;139(Pt 1):242-58. https://doi.org/10.1093/brain/awv328
  • 25 Stephan BCM, Minett T, Muniz-Terrera G, Harrison SL, Matthews FE, Brayne C. Neuropsychological profiles of vascular disease and risk of dementia: implications for defining vascular cognitive impairment no dementia (VCI-ND). Age Ageing. 2017 Sep;46(5):755-60. https://doi.org/10.1093/ageing/afx016
  • 26 Canneti B, Mosqueira AJ, Carreras T, Gago-Veiga AB, Onsurbe C, Ruiz M, Vivancos J. Differences in performance in CAMCOG-R domains between old and oldest old patients with Alzheimer’s disease. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2018;25(4):588-97. https://doi.org/10.1080/13825585.2017.1353679
  • 27 Huppert FA, Brayne C, Gill C, Paykel ES, Beardsall L. CAMCOG—A concise neuropsychological test to assist dementia diagnosis: Socio-demographic determinants in an elderly population sample. Br J Clin Psychol. 1995 Nov;34(4):529-41. https://doi.org/10.1111/j.2044-8260.1995.tb01487.x
  • 28 Moreira IFH, Bezerra AB, Sudo FK, Alves GS, Ericeira-Valente L, Tiel C, et al. CAMCOG – Valores das subescalas em idosos normais com nÍveis diferentes de escolaridade – Aspectos preliminares. Rev Bras Neurol. 2013 Jan-Mar;49(1):32-6.
  • 29 James KA, Grace LK, Thomas KG, Combrinck MI. Associations between CAMCOG-R subscale performance and formal education attainment in South African older adults. Int Psychogeriatr. 2014 Nov;1-10. https://doi.org/10.1017/S1041610214002233
  • 30 Gallagher D, Mhaolain AN, Coen R, Walsh C, Kilroy D, Belinski K, et al. Detecting prodromal Alzheimer’s disease in mild cognitive impairment: utility of the CAMCOG and other neuropsychological predictors. Int J Geriatr Psychiatry. 2010 Dec;25(12):1280-7. https://doi.org/10.1002/gps.2480
  • 31 Conde-Sala JL, Garre-Olmo J, Vilalta-Franch J, Llinás-Reglá J, Turró-Garriga O, Lozano Galleto M, et al. Predictors of cognitive decline in Alzheimer’s disease and mild cognitive impairment using the CAMCOG: a five-year follow-up. Int Psychogeriatr. 2012 Jun;24(6):948-58. https://doi.org/10.1017/S1041610211002158
  • 32 Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer’s disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds. Int Psychogeriatr. 2010 Feb;22(1):64-71. https://doi.org/10.1017/S1041610209991141
  • 33 Amaral-Carvalho V, Caramelli P. Normative data for healthy middle-aged and elderly performance on the Addenbrooke Cognitive Examination-Revised. Cogn Behav Neurol. 2012 Jun;25(2):72-6. https://doi.org/10.1097/WNN.0b013e318259594b
  • 34 de Araujo NB, Nielsen TR, Engedal K, Barca ML, Coutinho ES, Laks J. Diagnosing dementia in lower educated older persons: validation of a Brazilian Portuguese version of the Rowland Universal Dementia Assessment Scale (RUDAS). Braz J Psychiatry. 2018 Jul-Sep;40(3):264-9. https://doi.org/10.1590/1516-4446-2017-2284.
  • 35 Baker DP, Salinas D, Eslinger PJ. An envisioned bridge: Schooling as a neurocognitive developmental institution. Dev Cogn Neurosci. 2012 Feb;2 Suppl 1(Suppl 1):S6-17. https://doi.org/10.1016/j.dcn.2011.12.001
  • 36 Farfel JM, Nitrini R, Suemoto CK, Grinberg LT, Ferretti REL, Leite REP, et al. Very low levels of education and cognitive reserve: a clinicopathologic study. Neurologya. 2013 Aug;81(7):650-7. https://doi.org/10.1212/WNL.0b013e3182a08f1b
  • 37 Rosselli M, Ardila A, Matute E, Vélez-Uribe I. Language development across the life span: A neuropsychological/neuroimaging perspective. Neurosci J. 2014;2014:585237. https://doi.org/10.1155/2014/585237.
  • 38 Horowitz-Kraus T, Hutton JS. From emergent literacy to reading: how learning to read changes a child’s brain. Acta Paediatr. 2015 Jul;104(7):648-56. https://doi.org/10.1111/apa.13018
  • 39 Contador I, Del Ser T, Llama S, Villarejo A, Benito-León J, Bermejo-Pareja F. Impact of literacy and years of education on the diagnosis of dementia: A population-based study. J Clin Exp Neuropsychol. 2017 Mar;39(2):112-9. https://doi.org/10.1080/13803395.2016.1204992
  • 40 Leite KSB, Miotto EC, Nitrini R, Yassuda MS. Boston Naming Test (BNT) original, Brazilian adapted version and short forms: normative data for illiterate and low-educated older adults. Int Psychogeriatr. 2017 May;29(5):825-33. https://doi.org/10.1017/S1041610216001952
  • 41 Indicadores Sociais de Jundiaí: Censo 2010, IPRS, Futuridade, IDSUS e Segurança Pública. 2010 [accessed on Jan 29, 2021]. Available at: https://transparencia.jundiai.sp.gov.br/wp-content/uploads/relatorio_indicadores_jundiai_2012.pdf