Affiliation:
1. Enterprise Analytics Core, Elevance Health, Inc. Wilmington Delaware USA
2. Department of Health Policy and Management John Hopkins Bloomberg School of Public Health Baltimore Maryland USA
3. Sol Price School of Public Policy University of Southern California Los Angeles California USA
4. Leonard D. Schaeffer Center for Health Policy University of Southern California Los Angeles California USA
Abstract
AbstractBACKGROUNDSubjective cognitive impairment (SCI) measures in population‐based surveys offer potential for dementia surveillance, yet their validation against established dementia measures is lacking.METHODSWe assessed agreement between SCI and a validated probable dementia algorithm in a random one‐third sample (n = 1936) of participants in the 2012 National Health and Aging Trends Study (NHATS).RESULTSSCI was more prevalent than probable dementia (12.2% vs 8.4%). Agreement between measures was 90.0% and of substantial strength. Misclassification rates were higher among older and less‐educated subgroups due to higher prevalence of false‐positive misclassification but did not vary by sex or race and ethnicity.DISCUSSIONSCI sensitivity (63.4%) and specificity (92.5%) against dementia were comparable with similar metrics for the NHATS probable dementia measure against the “gold‐standard” Aging, Demographics, and Memory Study–based dementia criteria, implying that population‐based surveys may afford cost‐effective opportunities for dementia surveillance to assess risk and inform policy.Highlights
The prevalence of subjective cognitive impairment (SCI) is generally higher than that of a validated measure of probable dementia, particularly within the youngest age group, females, Whites, and persons with a college or higher degree.
Percent agreement between SCI and a validated measure of probable dementia was 90.0% and of substantial strength (prevalence‐ and bias‐adjusted kappa, 0.80). Agreement rates were higher in older and less‐educated subgroups, driven by the higher prevalence of false‐positive disagreement, but did not vary significantly by sex or race and ethnicity.
SCI's overall sensitivity and specificity were 63.4% and 92.5%, respectively, against a validated measure of probable dementia, suggesting utility as a low‐cost option for dementia surveillance. Heterogeneity in agreement quality across subpopulations warrants caution in its use for subgroup analyses.