Development of a Brief Screen to Detect Cognitive Impairment in Older Adults: The QuickSort

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 69; no. 2; pp. 441 - 449
• Main Authors: Foran, Amie M., Mathias, Jane L., Bowden, Stephen C.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.02.2021; Wiley Subscription Services, Inc
• Subjects: Cognitive ability; cognitive impairment; Neurodegenerative diseases; older adult; Older people; QuickSort; screening; older adult; QuickSort; screening; cognitive impairment
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16898

BACKGROUND Sorting tests detect cognitive decline in older adults who have a neurodegenerative disorder, such as Alzheimerʼs and Parkinsonʼs disease. Although equally effective at detecting impairment as other cognitive screens (e.g. Mini‐Mental State Examination (MMSE)), sorting tests are not commonly used in this context. This study examines the QuickSort, which is a new brief sorting test that is designed to screen older adults for cognitive impairment. DESIGN Observational cohort study. SETTING General community and inpatients, Australia. PARTICIPANTS Older (≥60 years) community‐dwelling adults (n = 187) and inpatients referred for neuropsychological assessment (n = 78). A normative subsample (n = 115), screened for cognitive and psychological disorders, was formed from the community sample. MEASUREMENTS Participants were administered the QuickSort, MMSE, Frontal Assessment Battery (FAB), and Depression Anxiety and Stress Scale‐21. The QuickSort requires people to sort nine stimuli by color, shape, and number, and to explain the basis for their correct sorts. Sorting (range = 0–12), Explanation (range = 0–6), and Total (range = 0–18) scores were calculated for the QuickSort. RESULTS The Cognitively Healthy subsample completed the QuickSort within 2 minutes, 50% had errorless performance, and 95% had Total scores of 10 or greater. The likelihood of community‐dwelling older adults and inpatients (n = 260) being impaired on either the MMSE or FAB, or both, increased by a factor of 3.75 for QuickSort Total scores of less than 10 and reduced by a factor of 0.23 for scores of 10 or greater. CONCLUSION The QuickSort provides a quick, reliable, and valid alternative to lengthier cognitive screens (e.g., MMSE and FAB) when screening older adults for cognitive impairment. The QuickSort performance of an older adult can be compared with a cognitively healthy normative sample and used to estimate the likelihood they will be impaired on either the MMSE or FAB, or both. Clinicians can also use evidence‐based modeling to customize the QuickSort for their setting.