Utility and validity of a brief cognitive assessment tool in patients with epileptic and nonepileptic seizures
Cognitive impairment is not uncommon in patients with epilepsy, and may relate to the underlying pathophysiology of epilepsy, the effects of seizures, or epilepsy treatment. Formal neuropsychological testing is not available in many centers, and few cognitive screening tools have been validated in an epilepsy population. We aimed to ascertain the reliability and validity of a multidimensional cognitive screening instrument, the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG), in a mixed epilepsy population. One hundred sixty-one of 177 consecutive patients admitted to a video telemetry unit were assessed with the NUCOG and classified with respect to seizure semiology, and a subset (n=33) were formally neuropsychologically assessed. Scores did not differ between patients with epileptiform, those with nonepileptiform, and those with mixed EEGs on the NUCOG, nor between patients with focal and those with generalized epilepsies. Patients with a temporal lobe focus performed more poorly in general, and in memory specifically, than patients with an extratemporal focus. Scores on the NUCOG subscales Memory, Attention, and Executive Functioning correlated significantly with neuropsychological testing of these same domains, although patients were not impaired on measures of language or spatial function. The NUCOG appears to correlate strongly with neuropsychological functioning in a number of key cognitive areas affected in patients with epilepsy, and appears to robustly detect memory impairment in patients with temporal lobe epilepsy.
- [Show abstract] [Hide abstract] ABSTRACT: Cognitive estimation, an ability to attribute measurements to concrete things, is relevant to adaptive behavior. This study evaluated cognitive estimation in patients with temporal lobe epilepsy (TLE) with the goal of verifying its relationship to temporal lobe damage and age of seizure onset. One hundred and eight patients with drug-resistant TLE and 51 healthy controls were evaluated using the Cognitive Estimation Task (CET), which requires simple and complex estimations providing the Total and Bizarreness scores. Different tests assessed reasoning, attention, executive, visuospatial, and lexical-semantic abilities. Patients with right TLE had earlier age of seizure onset than patients with left TLE and lower education than controls. Compared with controls, both patient groups obtained worse CET Total and Bizarreness scores, but only patients with right TLE were significantly impaired. Patients with seizure onset before age 12 showed worse scores than patients with later seizure onset irrespective of the side of TLE. The CET Total and Bizarreness scores were predicted by age of seizure onset and semantic fluency; the Bizarreness score also related to education, chronological age, and visual attention. Results highlight the complexity of the cognitive pattern associated with TLE. Cognitive estimation deficit primarily reflects early age of seizure onset and semantic difficulties. An involvement of visual mental operations mediated by the right hemisphere may accentuate the deficit, while cognitive reserve may play a protective role.0Comments 2Citations
- [Show abstract] [Hide abstract] ABSTRACT: We aimed to develop and validate a Chinese version of the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) for use in Chinese-speaking subjects internationally. Patients and healthy controls were recruited from two hospitals between July and October 2012. Receiver operating characteristic (ROC) curves were utilized to test criterion validity. Convergent validity was assessed via correlations between NUCOG and the Mini-Mental State Examination (MMSE). Reliability was measured by internal consistency (Cronbach's α). Patients with epilepsy (n=144), neurological diseases (n=81), dementia (n=44), and controls (n=260) completed the NUCOG and the MMSE. Overall, both NUCOG and MMSE scores differed significantly across the four groups with the highest scores in the control group and the lowest in the dementia group (p<0.0001). The NUCOG scores could differentiate between patients with certain seizure types, stroke and transient ischemic attack. Compared to the MMSE, the NUCOG exhibited a higher area under the ROC curve. The convergent validity was substantially correlated, and internal consistency was very high (0.922). The Chinese version of NUCOG was demonstrated to be a sensitive and reliable screening tool for cognitive impairment in a Chinese-speaking population not only in China, but also in countries where there is a sizeable population of ethnic Chinese. Additionally, our study also showed the NUCOG could better differentiate cognitive function in patients with certain seizure types, stroke and transient ischemic attack than the MMSE. This potentially expands the clinical usefulness of NUCOG, enabling clinicians to measure the cognitive profile of patients with epilepsy and ischemic cerebrovascular diseases.0Comments 0Citations
- [Show abstract] [Hide abstract] ABSTRACT: This study presents a systematic review of validity evidence for neuropsychological batteries. Studies published in international databases between 2005 and 2012 were examined. Considering the specificity of neuropsychological batteries, the aim of the study was to review the statistical analyses and procedures that have been used to validate these instruments. A total of 1,218 abstracts were read, of which 147 involved studies of neuropsychological batteries or tests that evaluated at least three cognitive processes. The full text of each article was analyzed according to publication year, focal instrument of the study, sample type, sample age range, characterization of the participants, and procedures and analyses used to provide evidence of validity. The results showed that the studies primarily analyzed patterns of convergence and divergence by correlating the instruments with other tests. Measures of reliability, such as internal consistency and test-retest reliability, were also frequently employed. To provide evidence of relationships between test scores and external criteria, the most common procedures were evaluations of sensitivity and specificity, and comparisons were made between contrasting groups. The statistical analyses frequently used were Receiver Operating Characteristic analysis, Pearson correlation, and Cronbach's alpha. We discuss the necessity of incorporating both classic and modern psychometric procedures and presenting a broader scope of validity evidence, which would represent progress in this field. Finally, we hope our findings will help researchers better plan the validation process for new neuropsychological instruments and batteries.0Comments 0Citations