Profiling Communication Ability in Dementia: Validation of a new cognitive‐communication assessment tool
Bibliographic record
Abstract
BACKGROUND: Individuals with dementia have communication limitations resulting from cognitive impairments that define the syndrome. Whereas there are numerous cognitive assessments for individuals with dementia, there are far fewer communication assessments. The Profiling Communication Ability in Dementia (P-CAD) was developed to address this gap. AIMS: The purpose of this study was to examine the concurrent validity, longitudinal validity and inter- and intra-rater reliability of the P-CAD in a population of people with dementia and their communication partners. METHOD: The P-CAD was administered to 122 people with dementia and their communication partners in Ireland (n = 100) and Canada (n = 22), over a 12-month period. To establish concurrent validity of the P-CAD, scores were compared to scores obtained from existing standardized instruments including the Functional Linguistic Communication Inventory (FLCI), the Mini-Mental State Examination (MMSE-2) and Global Deterioration Scale (GDS). Inter-rater reliability and responsiveness (longitudinal validity) were analysed using data from a subgroup of participants. OUTCOMES & RESULTS: Overall P-CAD test scores were significantly correlated with FLCI (n = 122; r = 0.875; p < 0.001) and MMSE-2 total scores (n = 122; r = 0.857; p < 0.001). Levels of communication support categories on the P-CAD correlated with GDS rankings (n = 122; rho = -0.539; p < 0.001) and MMSE-2 total scores (n = 122; rho = 0.680, p < 0.001). Inter-rater reliability tested for 20 participants in the Irish sample revealed high levels of agreement between raters in scoring the GDS (n = 20; ICC = 0.969, p < 0.001), MMSE-2 (n = 20; ICC = 0.997, p < 0.001), FLCI (n = 20; ICC = 0.999, p < 0.001) and P-CAD (n = 20; ICC = 0.981, p < 0.001). To establish longitudinal validity to examine if the P-CAD was responsive to changes in cognitive-communication function over time, 12 participants in the Irish sample repeated all tests 3 months after the initial testing. No statistically significant differences in test scores were found for the 12 participants who completed follow-up measures at this time point in any of the three scales. It was not possible to determine sufficient responsiveness as correlations between the change in P-CAD scores over 3 months were insignificant for both the change in MMSE-2 scores (rho = -0.130, p = 0.704) and the FLCI scores (rho = 0.221, p = 0.513). CONCLUSIONS & IMPLICATIONS: In this study, P-CAD has demonstrated good concurrent validity and inter-rater reliability in samples collected in two countries with English-speaking participants. The P-CAD is appropriate for use to evaluate communication abilities of people with dementia, including during conversational interactions with caregivers. WHAT THIS PAPER ADDS: What is already known on the subject Dementia alters the communication function of the person with dementia and impacts interactions with others. Speech and language therapists (SLTs) provide specific recommendations on communication function and support. However, they have limited access to comprehensive communication assessments to guide intervention. What this paper adds to the existing knowledge This validation study has confirmed that Profiling Communication Ability in Dementia (P-CAD) is a valid and reliable tool for SLTs to profile the communication abilities of people with dementia. It identifies the type and levels of communication support required as dementia progresses. The inclusion of communication partners in the study confirms their important role in providing conversation support to people with dementia. What are the potential or clinical implications of this work? The P-CAD is a clinical resource for dynamic communication assessment, which identifies key areas of retained ability to guide communication support and individualised intervention. It can be used with people at different stages and severity of dementia across a range of clinical settings. The P-CAD summary, which is part of the P-CAD, can be shared with family members and healthcare teams to enhance communication access for the person as dementia progresses.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".