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COST: Cognitive State Test, a brief screening battery for Alzheimer disease in illiterate and literate patients

Published online by Cambridge University Press:  09 November 2012

Gulsen Babacan-Yildiz ,
Ahmet T. Isik ,
Emel Ur ,
Emine Aydemir ,
Can Ertas ,
Merve Cebi ,
Pinar Soysal ,
Esra Gursoy ,
Mehmet Kolukisa  and
Gulsen Kocaman
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Gulsen Babacan-Yildiz*
Affiliation:
Department of Neurology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
Ahmet T. Isik
Affiliation:
Department of Geriatrics, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
Emel Ur
Affiliation:
Department of Neurology, Nevsehir Public Hospital, Nevsehir, Turkey
Emine Aydemir
Affiliation:
Department of Geriatrics, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
Can Ertas
Affiliation:
Department of Psychology, Okan University, Istanbul, Turkey
Merve Cebi
Affiliation:
Department of Psychology, Bogazici University, Istanbul, Turkey
Pinar Soysal
Affiliation:
Department of Geriatrics, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
Esra Gursoy
Affiliation:
Department of Neurology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
Mehmet Kolukisa
Affiliation:
Department of Neurology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
Gulsen Kocaman
Affiliation:
Department of Neurology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
Arif Celebi
Affiliation:
Department of Neurology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
*
Correspondence should be addressed to: Gulsen Babacan-Yildiz, Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih 34093 Istanbul, Turkey. Phone: +90 554 915 55 11; Fax: +90 212 533 23 26. Email: gbabacan@hotmail.com.
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Abstract

Background: The aim was to develop a brief screening battery, Cognitive State Test (COST), for detecting the presence of dementia in both illiterate and literate patients and to assess its validity and reliability.

Methods: COST is a cognitive screening tool that consists of almost all cognitive domains. It takes 5–7 minutes to administer, and has a maximum score of 30. Data were obtained from 114 healthy volunteers and 74 Alzheimer dementia (AD) patients. Subjects’ age divided into two groups: A1: <65 years; and A2: ≥65 years and their education level divided into three groups: E1: illiterate; E2: 1–5 years; and E3: ≥6 years. For assessing concurrent validity, total COST score was compared to the Clinical Dementia Rating (CDR), the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and Basic Activities of Daily Living (BADL). Sensitivity and specificity were determined through a discriminant analysis using the Receiver Operating Characteristic (ROC) curves. Internal consistency was measured using Cronbach's coefficient α.

Results: For normal and AD subjects, mean age was 64.9±9.8 years (50 women and 64 men) and 67.2±13.2 years (55 women and 19 men), respectively. Schooling ranged from 0–15 years (mean 5.7±4.2 and 3.3±3.8 years, respectively), and 21 and 37 subjects were illiterate, respectively. The COST significantly and positively correlated with MMSE and MoCA, and significantly and inversely correlated with CDR, the Geriatric Depression Scale (GDS), and BADL. In the E1, E2, and E3 education groups, the optimal cut-off points of COST chosen for diagnosis of AD were 23/24 (sensitivity: 81%, specificity: 99%), 24/25 (sensitivity: 75%, specificity: 86%), and 26/27 (sensitivity: 77%, specificity: 84%), respectively. When illiterate and literate subjects were then pooled, the optimal cut-off score of COST was 24/25, which yielded a sensitivity of 81% and a specificity of 87%. Reliability of the COST was good (0.86).

Conclusion: The COST is a valid and reliable screening battery for detection of dementia both in the illiterate and the literate Alzheimer patients.

Keywords

Alzheimer dementianeuropsychological evaluationscreening battery
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 3 , March 2013 , pp. 403 - 412
Copyright
Copyright © International Psychogeriatric Association 2012

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