Validity of Brief Cognitive Assessment Tool modifications for older adults with visual and motor limitations

Abstract

ABSTRACTIntroduction: The prevalence of cognitive, sensory, and physical impairments is expected to grow alongside increasing life expectancy. These chronic conditions pose challenges for geriatric assessment. We examined whether Brief Cognitive Assessment Tool (BCAT) modifications to accommodate visual and motor limitations would retain strong validity for identifying mild cognitive impairment (MCI) and dementia.Method: Psychometric analyses were performed on archival data (N = 458) from community-dwelling older adults and residents of assisted living facilities and nursing homes in Maryland, USA (age ≥ 50 years). Participants completed a brief testing battery, including the BCAT, and were assigned a cognitive diagnosis (normal cognition, MCI, mild dementia, moderate dementia, severe dementia) by licensed clinical psychologists.Results: Receiver operator characteristic curve analyses evidenced excellent diagnostic validity of BCAT modification cutoffs for identifying the cognitive categories. Contextual memory and executive control factors, which explained over 80% of variance in cognitive diagnoses, may account for the preservation of validity despite BCAT modifications.Conclusions: The results indicate strong psychometric evidence for the BCAT modifications and provide cutoffs for identifying MCI and staging dementia. For clinicians, the score guidelines are preferable to the guesswork involved with adjusting cutoffs to accommodate visual and motor limitations.