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The brief cognitive assessment tool (BCAT): cross-validation in a community dwelling older adult sample

Published online by Cambridge University Press:  13 August 2014

Elizabeth E. MacDougall ,
William E. Mansbach ,
Kristen Clark  and
Ryan A. Mace
Elizabeth E. MacDougall*
Affiliation:
Hood College, 401 Rosemont Avenue, Frederick, Maryland, Frederick, Maryland, USA
William E. Mansbach
Affiliation:
Mansbach Health Tools, LLC, , Simpsonville, Maryland, Simpsonville, Maryland, USA
Kristen Clark
Affiliation:
Mansbach Health Tools, LLC, , Simpsonville, Maryland, Simpsonville, Maryland, USA
Ryan A. Mace
Affiliation:
Mansbach Health Tools, LLC, , Simpsonville, Maryland, Simpsonville, Maryland, USA
*
Correspondence should be addressed to: Elizabeth E. MacDougall, Hood College, 401 Rosemont Avenue, Frederick, Maryland 21701, Phone: 301-696-3892; Fax: 301-696-3863. Email: macdougall@hood.edu.
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Abstract

Background:

Cognitive impairment is underrecognized and misdiagnosed among community-dwelling older adults. At present, there is no consensus about which cognitive screening tool represents the “gold standard.” However, one tool that shows promise is the Brief Cognitive Assessment Tool (BCAT), which was originally validated in an assisted living sample and contains a multi-level memory component (e.g. word lists and story recall items) and complex executive functions features (e.g. judgment, set-shifting, and problem-solving).

Methods:

The present study cross-validated the BCAT in a sample of 75 community-dwelling older adults. Participants completed a short battery of several individually administered cognitive tests, including the BCAT and the Montreal Cognitive Assessment (MoCA). Using a very conservative MoCA cut score of <26, the base rate of cognitive impairment in this sample was 35%.

Results:

Adequate internal consistency and strong evidence of construct validity were found. A receiver operating characteristic (ROC) curve was calculated from sensitivity and 1-specificity values for the classification of cognitively impaired versus cognitively unimpaired. The area under the ROC curve (AUC) for the BCAT was .90, p < 0.001, 95% CI [0.83, 0.97]. A BCAT cut-score of 45 (scores below 45 suggesting cognitive impairment) resulted in the best balance between sensitivity (0.81) and specificity (0.80).

Conclusions:

A BCAT cut-score can be used for identifying persons to be referred to appropriate healthcare professionals for more comprehensive cognitive assessment. In addition, guidelines are provided for clinicians to interpret separate BCAT memory and executive dysfunction component scores.

Keywords

psychometricsreliabilityvaliditycognitive impairmentscreeningolder adults
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 2 , February 2015 , pp. 243 - 250
Copyright
Copyright © International Psychogeriatric Association 2014 

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