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Item-level psychometrics of the Ascertain Dementia Eight-Item Informant Questionnaire.

ABSTRACT: The aim of this study is to evaluate the item-level psychometrics of the Ascertain Dementia Eight-Item Informant Questionnaire (AD-8) by examining its dimensionality, rating scale integrity, item fit statistics, item difficulty hierarchy, item-person match, and precision. We used confirmatory factor analysis and the Rasch rating scale model for analyzing the data extracted from the proxy versions of the 2019 and 2020 National Health and Aging Trends Study, USA. A total of 403 participants were included in the analysis. The confirmatory factor analysis with a 1-factor model using the robust weighted least squares (WLSMV) estimator indicated a unidimensional measurement structure (χ2 = 41.015, df = 20, p = 0.004; root mean square error of approximation = 0.051; comparative fit index = 0.995; Tucker-Lewis Index = 0.993;). The findings indicated that the AD-8 has no misfitting items and no differential item functioning across sex and gender. The items were evenly distributed in the item difficulty rating (range: -2.30 to 0.98 logits). While there were floor effects, the AD-8 revealed good reliability (Rasch person reliability = 0.67, Cronbach's alpha = 0.89). The Rasch analysis reveals that the AD-8 has excellent psychometric properties that can be used as a screening assessment tool in clinical settings allowing clinicians to measure dementia both quickly and efficiently. To summarize, the AD-8 could be a useful primary screening tool to be used with additional diagnostic testing, if the patient is accompanied by a reliable informant.

SUBMITTER: Ham Y

PROVIDER: S-EPMC9255723 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Dementia and mild cognitive impairment (MCI) are underrecognized in community settings. This may be due in part to the lack of brief dementia screening tools available to clinicians. We compared 2 brief, informant-based screening tests: the AD8 and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in a community-based neurology practice in the midwestern United States.We examined 186 consecutive patients (44 controls, 13 with MCI, and 129 with dementia). Receiver operator characteristic curves were used to examine the ability of AD8 and IQCODE to discriminate between controls and MCI or dementia. Sensitivity, specificity, predictive values, and likelihood ratios were reported.AD8 differentiated healthy controls from MCI (P<0.001) or dementia (P<0.001), and MCI from dementia (P=0.008). The IQCODE differentiated controls and MCI from dementia (both P<0.001), and between controls and MCI (P=0.002). Both AD8 (AUC=0.953; 95% confidence interval, 0.92-0.99) and IQCODE (AUC=0.930, 95% confidence interval, 0.88-0.97) provided discrimination between controls and patients with dementia; however, the AD8 had superior sensitivity detecting dementia (99.2%) and MCI (100%) compared with the IQCODE (79.1% for dementia, 46.1% for MCI) with nonoverlapping confidence intervals. Using published cut-offs (AD8?2, IQCODE?3.4), only 1 case of dementia was missed with the AD8, whereas the IQCODE failed to detect dementia in 27 individuals. The AD8 detected MCI in all 13 individuals, whereas the IQCODE misclassified 7 individuals.Both the AD8 and IQCODE were able to detect dementia in a community setting. The AD8, however, was more successful than IQCODE in detecting MCI. If simple and efficient screening for early cognitive impairment is the goal, particularly in the early stages (e.g., for prevention trials or public screening), the combination of an informant interview (the AD8) and a brief performance measure could be considered as they meet the basic requirements of the Personalized Prevention Plan for Medicare beneficiaries.

Project description:BackgroundWeb-based questionnaires are increasingly used in epidemiologic studies, as traditional methods are facing a decrease in response rates and an increase in costs. However, few studies have investigated factors related to the level of completion of internet-based epidemiologic questionnaires.ObjectiveOur objective was to identify person-level characteristics and item design factors associated with breakoff (not finishing the questionnaire) and item nonresponse in a Web-based questionnaire.MethodsThis study was a cross-sectional analysis of the baseline questionnaire, applied from 2005 to 2016, of the Italian NINFEA (Nascita e Infanzia: gli Effetti dell'Ambiente) birth cohort. The baseline questionnaire was administered to enrolled women, who could register at any time during pregnancy. We used logistic regression to analyze the influence of person-level factors on questionnaire breakoff, and a logistic multilevel model (first level: items of the questionnaire; second level: sections of the questionnaire; third level: study participants) to analyze the influence of person-level and item design factors on item nonresponse. Since the number of applicable items depended on the respondent's characteristics and breakoff, we used inverse probability weighting to deal with missing by design.ResultsOf 5970 women, 519 (8.69%) did not finish the questionnaire. Older age (adjusted odds ratio 1.40, 95% CI 1.05-1.88), lower educational level (adjusted odds ratio [OR] 1.53, 95% CI 1.23-1.90), and earlier stage of pregnancy (adjusted OR 3.01, 95% CI 2.31-3.92) were positively associated with questionnaire breakoff. Of the 1,062,519 applicable items displayed for the participants, 22,831 were not responded to (overall prevalence of item nonresponse 2.15%). Item nonresponse was positively associated with older age (adjusted OR 1.25, 95% CI 1.14-1.38), being in the first trimester of pregnancy (adjusted OR 1.18, 95% CI 1.06-1.31), and lower educational level (adjusted OR 1.23, 95% CI 1.14-1.33). Dropdown menu items (adjusted OR 1.77, 95% CI 1.56-2.00) and items organized in grids (adjusted OR 1.69, 95% CI 1.49-1.91) were positively associated with item nonresponse.ConclusionsIt is important to use targeted strategies to keep participants motivated to respond. Item nonresponse in internet-based questionnaires is affected by person-level and item design factors. Some item types should be limited to reduce item nonresponse.

Project description:BackgroundReducing the number of items in a questionnaire while maintaining relevant information is important as it is associated with advantages such as higher respondent engagement and reduced response error. However, in health care, after the original design, an a posteriori check of the included items in a questionnaire is often overlooked or considered to be of minor importance. When conducted, this is often based on a single selected method. We argue that before finalizing any lifestyle questionnaire, a posteriori validation should always be conducted using multiple approaches to ensure the robustness of the results.ObjectiveThe objectives of this study are to compare the results of two statistical methods for item reduction (variance inflation factor [VIF] and factor analysis [FA]) in a lifestyle questionnaire constructed by combining items from different sources and analyze the different results obtained from the 2 methods and the conclusions that can be made about the original items.MethodsData were collected from 79 participants (heterogeneous in age and sex) with a high risk of metabolic syndrome working in a financial company based in Tokyo. The lifestyle questionnaire was constructed by combining items (asked with daily, weekly, and monthly frequency) from multiple validated questionnaires and other selected questions. Item reduction was conducted using VIF and exploratory FA. Adequacy tests were used to check the data distribution and sampling adequacy.ResultsAmong the daily and weekly questions, both VIF and FA identified redundancies in sleep-related items. Among the monthly questions, both approaches identified redundancies in stress-related items. However, the number of items suggested for reduction often differed: VIF suggested larger reductions than FA for daily questions but fewer reductions for weekly questions. Adequacy tests always confirmed that the structural detection was adequate for the considered items.ConclusionsAs expected, our analyses showed that VIF and FA produced both similar and different findings, suggesting that questionnaire designers should consider using multiple methods for item reduction. Our findings using both methods indicate that many questions, especially those related to sleep, are redundant, indicating that the considered lifestyle questionnaire can be shortened.

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Item-level psychometrics of the Ascertain Dementia Eight-Item Informant Questionnaire.

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