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Measuring Cognition: Common Instrument Development in Health Surveys

This working paper discusses the challenges of measuring cognition in health surveys and proposes a set of items to assess memory, concentration, thinking, and problem-solving. It highlights the importance of accurately capturing cognitive functioning across different facets and suggests a streamlined approach for improved precision in measurement. The paper also examines existing instruments like the WHOQOL-100 and presents a new framework for assessing cognition in health status surveys. The proposed items aim to provide a comprehensive overview of cognitive function and offer a structured method for data collection and analysis.

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Measuring Cognition: Common Instrument Development in Health Surveys

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  1. Working Paper No.3 Add.7 22 November 2005 STATISTICAL COMMISSION and STATISTICAL OFFICE OF THE UN ECONOMIC COMMISSION FOR EUROPEAN COMMUNITIES EUROPE (EUROSTAT) CONFERENCE OF EUROPEAN WORLD HEALTH STATISTICIANS ORGANIZATION (WHO) Joint UNECE/WHO/Eurostat Meeting on the Measurement of Health Status (Budapest, Hungary, 14-16 November 2005) Session 3-Invited paper Task Force on the Development of a Common Instrument to Measure Health States:Measuring Cognition Cameron N. McIntosh; Sarah Connor Gorber; Julie Bernier; Jean-Marie Berthelot; Michael C. Wolfson Statistics Canada

  2. Issues in Measuring Cognition • Cognition is a multi-faceted health domain (e.g., memory, concentration, thinking, problem-solving) • many instruments place multiple facets of Cognition along the same functional status continuum, for example: “Able to remember most things, think clearly and solve day to day problems” (Cognition, Level 1, HUI3) “I am able to think clearly and logically, and my memory functions well” (Mental Function, Level 1, 15D) • Double- or triple-barrelled approach makes it problematic to accurately assess where limitations are in cognitive functioning

  3. Issues in Measuring Cognition • the WHOQOL-100 assesses various facets of Cognition separately, for example: “How well are you able to concentrate?” “How would you rate your memory?” • similarly, the intention of the task force in designing the common instrument was to uniquely assess four core facets of Cognition: memory, concentration, thinking, and problem-solving • increase in survey administration time may be worth the increase in measurement precision

  4. Proposed Items for Cognition: Set A Preamble: “The next few questions ask about [your/his/her] level of cognitive functioning, for example, [your/his/her] usual ability to concentrate, remember things, think, and solve daily problems. • COG-1A. How much difficulty [do/does] [you/he/she] usually have in concentrating on things? [INTERVIEWER: Read categories to respondent] 1 no difficulty 2 a little bit of difficulty 3 quite a bit of difficulty 4 a great deal of difficulty 5 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b140 (Attention Functions); d160 (Focusing Attention)

  5. Proposed Items for Cognition: Set A • COG-2A. How much difficulty [do/does] [you/he/she] usually have in remembering things? [INTERVIEWER: Read categories to respondent] 1 no difficulty 2 a little bit of difficulty 3 quite a bit of difficulty 4 a great deal of difficulty 5 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b144 (Memory Functions)

  6. Proposed Items for Cognition: Set A • COG-3A. How much difficulty [do/does] [you/he/she] usually have in thinking clearly and logically? [INTERVIEWER: Read categories to respondent] 1 no difficulty 2 a little bit of difficulty 3 quite a bit of difficulty 4 a great deal of difficulty 5 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b1601 (Form of Thought); d163 (Thinking)

  7. Proposed Items for Cognition: Set A • COG-4A. How much difficulty [do/does] [you/he/she] usually have in solving daily problems? [INTERVIEWER: Read categories to respondent] 1 no difficulty 2 a little bit of difficulty 3 quite a bit of difficulty 4 a great deal of difficulty 5 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b1646 (Problem-solving); d175 (Solving problems)

  8. Proposed Items for Cognition: Set B Preamble: “The next few questions ask about [your/his/her] level of cognitive functioning during the past ___ days, such as [your/his/her] ability to concentrate, remember things, think, and solve daily problems. When answering these questions, please try and focus only on [your/his/her] life during the past ___ days. • COG-1B. Overall during the past ___ days, how much difficulty [did] [you/he/she] have in concentrating on things? [INTERVIEWER: Read categories to respondent] 1 no difficulty 2 a little bit of difficulty 3 quite a bit of difficulty 4 a great deal of difficulty 5 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b140 (Attention Functions); d160 (Focusing Attention)

  9. Proposed Items for Cognition: Set B • COG-2B. Overall during the past ___ days, how much difficulty [did] [you/he/she] have in remembering things? [INTERVIEWER: Read categories to respondent] 1 no difficulty 2 a little bit of difficulty 3 quite a bit of difficulty 4 a great deal of difficulty 5 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b144 (Memory Functions)

  10. Proposed Items for Cognition: Set B • COG-3B. Overall during the past ___ days, how much difficulty [did] [you/he/she] have in thinking clearly and logically? [INTERVIEWER: Read categories to respondent] 1 no difficulty 2 a little bit of difficulty 3 quite a bit of difficulty 4 a great deal of difficulty 5 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b1601 (Form of Thought); d163 (Thinking)

  11. Proposed Items for Cognition: Set B • COG-4B. Overall during the past ___ days, how much difficulty [did] [you/he/she] have in solving daily problems? [INTERVIEWER: Read categories to respondent] 1 no difficulty 2 a little bit of difficulty 3 quite a bit of difficulty 4 a great deal of difficulty 5 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b1646 (Problem-solving); d175 (Solving problems)

  12. Proposed Items for Cognition: Set C Preamble: “The next few questions ask about [your/his/her] level of cognitive functioning during the past ___ days, such as [your/his/her] ability to concentrate, remember things, think, and solve daily problems. For answering each of these questions, you will be asked to use a rating scale that goes from 0 to 100. 0 means that [you/he/she] had extreme or complete difficulty with cognitive functioning, and 100 means that you had no difficulty with cognitive functioning. On this scale, we would like you to choose a number anywhere from 0 to 100 that best describes [your/his/her] level of cognitive functioning. When answering these questions, please try and focus only on [your/his/her] life during the past ___ days. COG-1C. Overall during the past ___ days, how much difficulty [did] [you/he/she] have in concentrating on things? [INTERVIEWER: Present scale to respondent and say: “Please choose the number from 0 to 100 that best describes how much difficulty [you/he/she] had in concentrating on things over the past ___ days”] completely unable to concentrateno difficulty in concentrating |____________________________________________________| 0 100 Relevant ICF Categories: b140 (Attention Functions); d160 (Focusing Attention)

  13. Proposed Items for Cognition: Set C COG-2C. Overall during the past ___ days, how much difficulty [did] [you/he/she] have in remembering things? Please use the following scale to rate how much difficulty [you/he/she] had in remembering things: [INTERVIEWER: Present scale to respondent and say: “Please choose the number from 0 to 100 that best describes how much difficulty [you/he/she] had in remembering things over the past ___ days”] completely unable to remember things no difficulty remembering things |____________________________________________________| 0 100 Relevant ICF Categories: b144 (Memory Functions)

  14. Proposed Items for Cognition: Set C COG-3C. Overall during the past ___ days, how much difficulty [did] [you/he/she] have in thinking clearly and logically? [INTERVIEWER: Present scale to respondent and say: “Please choose the number from 0 to 100 that best describes how much difficulty [you/he/she] had in thinking clearly and logically over the past ___ days”] completely unable to think no difficulty thinking clearly and logically clearly and logically |____________________________________________________| 0 100 Relevant ICF Categories: b1601 (Form of Thought); d163 (Thinking)

  15. Proposed Items for Cognition: Filter COG-1B-F. Overall during the past ___ days, did you have any difficulty [did] [you/he/she] have in concentrating on things? [INTERVIEWER: Read categories to respondent] 1 no 2 yes Yes (Go to question COG-1B) No (Go to question COG-2B-F) Don’t Know, Refusal (Go to question COG-2B-F) Relevant ICF Categories: b140 (Attention Functions); d160 (Focusing Attention)

  16. Proposed Items for Cognition: Follow-up to Filter Question COG-1B. Overall during the past ___ days, how much difficulty [did] [you/he/she] have in concentrating on things? [INTERVIEWER: Read categories to respondent] 1 a little bit of difficulty 2 quite a bit of difficulty 3 a great deal of difficulty 4 complete difficulty/unable to do it at all Don’t Know, Refusal (Go to next question) Relevant ICF Categories: b140 (Attention Functions); d160 (Focusing Attention)

  17. Broad Questions • Are any of the three approaches (i.e., no recall period, specific recall period, VAS) obviously superior, or is it worthwhile to subject all three to cognitive testing? • Is it worthwhile to use filter questions?

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