Cleveland Clinic Cognitive Battery (C3B): Normative, Reliability, and Validation Studies of a Self-Administered Computerized Tool for Screening Cognitive Dysfunction in Primary Care

Author:

Rao Stephen M.1,Galioto Rachel2,Sokolowski Megan1,Pierce Madelyn1,Penn Lisa1,Sturtevant Anna1,Skugor Blazenka3,Anstead Brent4,Leverenz James B.1,Schindler David56,Blum David6,Alberts Jay L.5,Posk Lori7

Affiliation:

1. Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

2. Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

3. Twinsburg Family Health and Surgery Center, Internal Medicine and Geriatrics Department, Twinsburg, OH, USA

4. Family Medicine, Hillcrest Hospital, Cleveland Clinic, Mayfield Heights, OH, USA

5. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

6. Qr8 Health, Inc., Cleveland, OH, USA

7. Health and Wellness Center, Cleveland Clinic, Vero Beach, FL, USA

Abstract

Background: The self-administered iPad-based Cleveland Clinic Cognitive Battery (C3B) was designed specifically for the efficient screening of cognitive functioning of older adults in a primary care setting. Objective: 1) Generate regression-based norms from healthy participants to enable demographic corrections to facilitate clinical interpretation; 2) estimate test-retest reliability and practice effects; 3) examine ability to discriminate mild cognitive impairment (MCI) from healthy aging; 4) d etermine validity of screening in a distracting clinical environment; and 5) determine completion rates and patient satisfaction in a primary care setting. Methods: Study 1 (S1) recruited a stratified sample of 428 healthy adults, ages 18–89, to generate regression-based equations. S2 assessed 2-week test-retest reliability and practice effects in 30 healthy elders. S3 recruited 30 MCI patients and 30 demographically-matched healthy controls. In S4, 30 healthy elders self-administered the C3B in a distracting environment and in a quiet private room in counterbalanced order. In a demonstration project, 470 consecutive primary care patients were administered the C3B as part of routine clinical care (S5). Results: C3B performance was primarily influenced by age, education, and race (S1), had acceptably high test-retest reliability and minimal practice effects (S2), discriminated MCI from healthy controls (S3), was not negatively impacted by a distracting clinical environment (S4), had high completion rates (>92%) and positive ratings from primary care patients (S5). Conclusion: The C3B is a computerized cognitive screening tool that is reliable, validated, self-administered, and is conducive to integration into a busy primary care clinical workflow for detecting MCI, early Alzheimer’s disease, and other related dementias.

Publisher

IOS Press

Subject

Psychiatry and Mental health,Geriatrics and Gerontology,Clinical Psychology,General Medicine,General Neuroscience

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