Application and validation of an algorithmic classification of early impairment in cognitive performance

Yurun Cai, Jennifer A. Schrack, Yuri Agrawal, Nicole M. Armstrong, Amal Wanigatunga, Melissa Kitner-Triolo, Abhay Moghekar, Luigi Ferrucci, Eleanor M. Simonsick, Susan M. Resnick, Alden L. Gross

Research output: Contribution to journalArticlepeer-review


Objective: Due to the long prodromal period for dementia pathology, approaches are needed to detect cases before clinically recognizable symptoms are apparent, by which time it is likely too late to intervene. This study contrasted two theoretically-based algorithms for classifying early cognitive impairment (ECI) in adults aged ≥50 enrolled in the Baltimore Longitudinal Study of Aging. Method: Two ECI algorithms were defined as poor performance (1 standard deviation [SD] below age-, sex-, race-, and education-specific means) in: (1) Card Rotations or California Verbal Learning Test (CVLT) immediate recall and (2) ≥1 (out of 2) memory or ≥3 (out of 6) non-memory tests. We evaluated concurrent criterion validity against consensus diagnoses of mild cognitive impairment (MCI) or dementia and global cognitive scores using receiver operating characteristic (ROC) curve analysis. Predictive criterion validity was evaluated using Cox proportional hazards models to examine the associations between algorithmic status and future adjudicated MCI/dementia. Results: Among 1,851 participants (mean age = 65.2 ± 11.8 years, 50% women, 74% white), the two ECI algorithms yielded comparably moderate concurrent criterion validity with adjudicated MCI/dementia. For predictive criterion validity, the algorithm based on impairment in Card Rotations or CVLT immediate recall was the better predictor of MCI/dementia (HR = 3.53, 95%CI: 1.59–7.84) over 12.3 follow-up years. Conclusions: Impairment in visuospatial ability or memory may be capable of detecting early cognitive changes in the preclinical phase among cognitively normal individuals.

Original languageEnglish (US)
Pages (from-to)2187-2192
Number of pages6
JournalAging and Mental Health
Issue number11
StatePublished - 2023


  • Alzheimer’s disease
  • classification
  • cognitive dysfunction
  • longitudinal studies
  • neuropsychological tests
  • validation study

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Gerontology
  • Phychiatric Mental Health


Dive into the research topics of 'Application and validation of an algorithmic classification of early impairment in cognitive performance'. Together they form a unique fingerprint.

Cite this