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Advancing the Use of Brief Cognitive Tests - Establishing Norms, Clinically Relevant Changes and Predictive Models

Borland, Emma LU orcid (2024) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Introduction: It is important to understand how to interpret and utilize cognitive
assessment results for diagnosis, treatment, and inclusion in clinical studies. As
treatments for neurodegenerative diseases advance, the need to identify cognitive
decline in its earliest stages is becoming increasingly important, both for the timely
initiation of treatment and for assessing the efficacy of interventions in clinical
trials. For early identification, accurate cognitive test cut-offs derived from a
suitable population are essential. It is also important to identify a clinically
meaningful change in cognitive test scores, which is essential when following
patients in clinic with repeated assessments, as well as... (More)
Introduction: It is important to understand how to interpret and utilize cognitive
assessment results for diagnosis, treatment, and inclusion in clinical studies. As
treatments for neurodegenerative diseases advance, the need to identify cognitive
decline in its earliest stages is becoming increasingly important, both for the timely
initiation of treatment and for assessing the efficacy of interventions in clinical
trials. For early identification, accurate cognitive test cut-offs derived from a
suitable population are essential. It is also important to identify a clinically
meaningful change in cognitive test scores, which is essential when following
patients in clinic with repeated assessments, as well as when using cognition as an
outcome in clinical trials. This is especially relevant as clinical trials increasingly
feature novel composites of cognitive tests. We also need methods to predict which
individuals seeking healthcare are at high risk of progressing to dementia in the near
future and which individuals are at low risk.

Methods: Participants from The Malmö Food and Diet, BioFINDER-1, and the
Alzheimer’s Disease Neuroimaging Initiative studies have been included in this
thesis. These studies all include individuals with and without cognitive impairment,
facilitating research in early diagnostic strategies for cognitive decline.

Results: In this thesis, we established Swedish MoCA cut-offs for cognitive
impairment for the primary assessment of cognitive impairment. We presented a
new approach to establish normative data for brief cognitive assessments for
identifying early cognitive changes in preclinical dementias. We have also identified
potential minimal clinically important differences (MCIDs) for cognitively
unimpaired individuals and individuals with mild cognitive impairment on a range
of cognitive test outcomes. Furthermore, we explored methods to predict a
composite cognitive measure for predicting a cognitive decline and to predict
progression to dementia for those with mild cognitive symptoms. Finally, we
created a two-step prediction model for predicting overall dementia for individuals
with mild cognitive symptoms.

Discussion: In our ageing population with increasing education levels and various
comorbidities, it is important to update guidelines for test norms, MCIDs and
methods for predicting cognitive decline. This can aid in optimal management and
early treatment, including timely referral to specialized units for enhanced
diagnostics of high-risk patients. (Less)
Abstract (Swedish)
Allt eftersom behandlingar för neurodegenerativa sjukdomar utvecklas, har tidig identifiering av kognitiv försämring blivit allt viktigare för att kunna påbörja en snabb intervention och bedöma behandlingens effektivitet. Denna avhandling undersöker olika aspekter av kognitiv testning relaterad till neurokognitiva störningar.
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • docent Steen Frederiksen, Kristian, Department of Clinical Medicine, University of Copenhagen
organization
publishing date
type
Thesis
publication status
published
subject
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2024:107
pages
104 pages
publisher
Lund University, Faculty of Medicine
defense location
Jubileumsaulan, Jan Waldenströms gata 5, Skånes Universitetssjukhus i Malmö. Join by Zoom: https://lu-se.zoom.us/j/66521160779?pwd=a1al1g6M7Ws1mpeWs73vlSBNVnxSH2.1
defense date
2024-10-04 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-603-6
language
English
LU publication?
yes
id
c9530a27-0b9b-4332-9119-a5e2d943c709
date added to LUP
2024-09-03 11:07:40
date last changed
2025-04-04 14:16:21
@phdthesis{c9530a27-0b9b-4332-9119-a5e2d943c709,
  abstract     = {{Introduction: It is important to understand how to interpret and utilize cognitive<br/>assessment results for diagnosis, treatment, and inclusion in clinical studies. As<br/>treatments for neurodegenerative diseases advance, the need to identify cognitive<br/>decline in its earliest stages is becoming increasingly important, both for the timely<br/>initiation of treatment and for assessing the efficacy of interventions in clinical<br/>trials. For early identification, accurate cognitive test cut-offs derived from a<br/>suitable population are essential. It is also important to identify a clinically<br/>meaningful change in cognitive test scores, which is essential when following<br/>patients in clinic with repeated assessments, as well as when using cognition as an<br/>outcome in clinical trials. This is especially relevant as clinical trials increasingly<br/>feature novel composites of cognitive tests. We also need methods to predict which<br/>individuals seeking healthcare are at high risk of progressing to dementia in the near<br/>future and which individuals are at low risk.<br/><br/>Methods: Participants from The Malmö Food and Diet, BioFINDER-1, and the<br/>Alzheimer’s Disease Neuroimaging Initiative studies have been included in this<br/>thesis. These studies all include individuals with and without cognitive impairment,<br/>facilitating research in early diagnostic strategies for cognitive decline.<br/><br/>Results: In this thesis, we established Swedish MoCA cut-offs for cognitive<br/>impairment for the primary assessment of cognitive impairment. We presented a<br/>new approach to establish normative data for brief cognitive assessments for<br/>identifying early cognitive changes in preclinical dementias. We have also identified<br/>potential minimal clinically important differences (MCIDs) for cognitively<br/>unimpaired individuals and individuals with mild cognitive impairment on a range<br/>of cognitive test outcomes. Furthermore, we explored methods to predict a<br/>composite cognitive measure for predicting a cognitive decline and to predict<br/>progression to dementia for those with mild cognitive symptoms. Finally, we<br/>created a two-step prediction model for predicting overall dementia for individuals<br/>with mild cognitive symptoms.<br/><br/>Discussion: In our ageing population with increasing education levels and various<br/>comorbidities, it is important to update guidelines for test norms, MCIDs and<br/>methods for predicting cognitive decline. This can aid in optimal management and<br/>early treatment, including timely referral to specialized units for enhanced<br/>diagnostics of high-risk patients.}},
  author       = {{Borland, Emma}},
  isbn         = {{978-91-8021-603-6}},
  issn         = {{1652-8220}},
  language     = {{eng}},
  number       = {{2024:107}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Advancing the Use of Brief Cognitive Tests - Establishing Norms, Clinically Relevant Changes and Predictive Models}},
  url          = {{https://lup.lub.lu.se/search/files/194442680/e-spik_ex_Emma.pdf}},
  year         = {{2024}},
}