Development and validation of a brief cognitive assessment tool

The sweet 16

Tamara G. Fong, Richard N. Jones, James L. Rudolph, Frances Margaret Yang, Douglas Tommet, Daniel Habtemariam, Edward R. Marcantonio, Kenneth M. Langa, Sharon K. Inouye

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16. Methods: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P < .001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03). Conclusions: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

Original languageEnglish (US)
Pages (from-to)432-437
Number of pages6
JournalArchives of Internal Medicine
Volume171
Issue number5
DOIs
StatePublished - Mar 14 2011

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Area Under Curve
Population Dynamics
Dementia
Hospitalization
Education
Cognitive Dysfunction
Surveys and Questionnaires

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Fong, T. G., Jones, R. N., Rudolph, J. L., Yang, F. M., Tommet, D., Habtemariam, D., ... Inouye, S. K. (2011). Development and validation of a brief cognitive assessment tool: The sweet 16. Archives of Internal Medicine, 171(5), 432-437. https://doi.org/10.1001/archinternmed.2010.423

Development and validation of a brief cognitive assessment tool : The sweet 16. / Fong, Tamara G.; Jones, Richard N.; Rudolph, James L.; Yang, Frances Margaret; Tommet, Douglas; Habtemariam, Daniel; Marcantonio, Edward R.; Langa, Kenneth M.; Inouye, Sharon K.

In: Archives of Internal Medicine, Vol. 171, No. 5, 14.03.2011, p. 432-437.

Research output: Contribution to journalArticle

Fong, TG, Jones, RN, Rudolph, JL, Yang, FM, Tommet, D, Habtemariam, D, Marcantonio, ER, Langa, KM & Inouye, SK 2011, 'Development and validation of a brief cognitive assessment tool: The sweet 16', Archives of Internal Medicine, vol. 171, no. 5, pp. 432-437. https://doi.org/10.1001/archinternmed.2010.423
Fong TG, Jones RN, Rudolph JL, Yang FM, Tommet D, Habtemariam D et al. Development and validation of a brief cognitive assessment tool: The sweet 16. Archives of Internal Medicine. 2011 Mar 14;171(5):432-437. https://doi.org/10.1001/archinternmed.2010.423
Fong, Tamara G. ; Jones, Richard N. ; Rudolph, James L. ; Yang, Frances Margaret ; Tommet, Douglas ; Habtemariam, Daniel ; Marcantonio, Edward R. ; Langa, Kenneth M. ; Inouye, Sharon K. / Development and validation of a brief cognitive assessment tool : The sweet 16. In: Archives of Internal Medicine. 2011 ; Vol. 171, No. 5. pp. 432-437.
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abstract = "Background: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16. Methods: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P < .001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80{\%} and a specificity of 70{\%}, whereas an MMSE score of less than 24 showed a sensitivity of 64{\%} and a specificity of 86{\%} against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99{\%} and a specificity of 72{\%} in contrast to an MMSE score with a sensitivity of 87{\%} and a specificity of 89{\%}. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03). Conclusions: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.",
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AU - Tommet, Douglas

AU - Habtemariam, Daniel

AU - Marcantonio, Edward R.

AU - Langa, Kenneth M.

AU - Inouye, Sharon K.

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