Dual-Stage Cognitive Assessment (DuCA)

Abstract

The Dual-Stage Cognitive Assessment (DuCA), introduced by Cui et al. in 2023, is a specialized, two-part screening tool engineered for efficient evaluation of cognitive function in high-throughput environments such as primary care settings. The initial stage (Part 1) provides a rapid assessment, focusing on verbal fluency, visual perception, and delayed recall, designed to be administered in approximately three minutes.

Individuals whose performance suggests potential cognitive impairment proceed to the second, more comprehensive stage (Part 2). This stage evaluates additional domains, including auditory sentence memory, category switching (a measure of executive function), and visual memory. The final DuCA total score is derived from the combined scores of both parts, providing a comprehensive measure. The DuCA has been validated in community-dwelling older adults, successfully differentiating between normal cognition, Mild Cognitive Impairment (MCI), and Alzheimer’s Disease (AD), demonstrating robust reliability and discriminative capabilities.

Keywords

Cognitive Function, Cognitive Impairment, Cognitive Screening, Cut-Off Values, Geriatric Assessment, Primary Care, Alzheimer’s Disease, Mild Cognitive Impairment, Screening Tests

Authors

Cui, Liang, Zhang, Zhen, Huang, Lin, Li, Qinjie, Guo, Yin-Han, Guo, Qi-Hao

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Purpose

The core objective of the Dual-Stage Cognitive Assessment (DuCA) is the early and accurate identification of adults exhibiting signs of cognitive impairment. It is specifically structured to offer a comprehensive, multidomain assessment tool that is practical for use in busy clinical settings.

The instrument encompasses evaluations of key cognitive domains including verbal functions, executive functions, visuospatial abilities, and a detailed assessment of memory function. Its dual-stage design maximizes efficiency, allowing clinicians to screen a broad population quickly while reserving the more time-intensive second stage for high-risk individuals.

Construct

The DuCA measures a broad spectrum of neurocognitive abilities essential for detecting early stages of cognitive decline. The primary constructs assessed are divided between the two parts of the instrument.

Part 1 focuses on foundational cognitive resources, including Verbal Fluency and basic Visual Perception, alongside Delayed Recall, a critical indicator of episodic memory function. Part 2 expands this scope to include more complex domains, such as Auditory Sentence Memory, Visual Memory, and Category Switching, which is a key indicator of executive control and mental flexibility.

Additionally, the assessment includes specialized items evaluating prospective memory (the ability to remember to perform an action in the future) and metamemory (self-awareness of one’s own memory capabilities), although these items are included for supplementary data collection and do not contribute to the final DuCA total score.

Validity

The DuCA has demonstrated strong validity, particularly in its ability to discriminate between diagnostic groups. The DuCA-Part 1 showed a reliable ability to distinguish Alzheimer’s Disease (AD) cases, yielding an Area Under the Curve (AUC) of 0.87 (95% CI 0.848–0.883). This performance was comparable to other established screeners, such as the ACE III (AUC = 0.86) and the MoCA-B (AUC = 0.85).

Crucially, the DuCA-total score significantly enhanced this discriminative capability, achieving a higher AUC of 0.93 (95% CI: 0.917–0.942) for AD detection. Analysis of specific cutoff scores indicated that a DuCA-total score of ≤ 15 provided excellent sensitivity (98.5%) and good specificity (80.0%). A more conservative cutoff of ≤ 13 maintained strong discrimination with 85.5% sensitivity and 90.8% specificity.

The DuCA-total also proved superior in discriminating various subtypes of Mild Cognitive Impairment (MCI) based on memory profiles. The AUC values were 0.89 for MCI-A (auditory memory impaired), 0.96 for MCI-AV (auditory and visual memory impaired), and 0.91 for other MCI subtypes, highlighting its utility in detailed differential diagnosis.

Reliability

The reliability of the DuCA was assessed using multiple psychometric indices, indicating that the instrument is stable and consistent.

Regarding Internal Consistency, the standardized Cronbach’s coefficient for DuCA Part 1 was 0.56. When evaluating the entire assessment, the coefficient for the DuCA total score was 0.78, which is generally considered acceptable for comprehensive clinical instruments.

Both Inter-Rater Reliability and Test-Retest Reliability were found to be excellent. The inter-rater reliability for the total score was reported as 0.98, confirming that the assessment results are highly consistent regardless of the administrator. Similarly, the test-retest consistency, measured over a two-week interval, was 0.95, demonstrating exceptional stability over time.

Factor Analysis

Based on the available published data, no formal factor analysis has been indicated or reported for the Dual-Stage Cognitive Assessment (DuCA).

Instrument

Test Type: Original Screener

Format: The DuCA is a dual-stage assessment with a maximum total score of 38 points. Part 1 contributes 10 points (Verbal Fluency: 2 points; Visual Perception: 3 points; Delayed Recall: 5 points). Part 2 contributes 28 points (Auditory Sentence Memory: 6 points; Category Switching: 10 points; Visual Memory: 12 points). The final score is the summation of points achieved in Part 1 and Part 2. Supplemental items assessing prospective memory and metamemory are included but are not factored into the total score.

Language Available: Chinese

Population Group: Human; Male; Female

Age Group: Adulthood (18 yrs & older); Middle Age (40-64 yrs); Aged (65 yrs & older)

Population Details: The scale was developed and validated in China, involving community-dwelling older adults categorized as having normal cognition, mild cognitive impairment, or Alzheimer’s disease.

Test Methodology: Test Reliability; Internal Consistency; Interrater Reliability; Test-Retest Reliability; Test Sensitivity; Test Specificity

Keywords

Cognitive function, Cognitive impairment, Cognitive screening, Cut-off values, Geriatric assessment, Primary care, Alzheimer’s Disease, Cutting scores, Primary Health Care, Screening Tests, Mild Cognitive Impairment

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Authors

Author ORCID Identifier: No data is Available

Affiliation Email addresses: No data is Available

Correspondence Address: Guo, Qi-Hao: Shanghai Jiao Tong University School of Medicine, Department of Gerontology, Shanghai Sixth People’s Hospital, Shanghai, China, 200233, [email protected]

Affiliations:

• Cui, Liang: Shanghai Jiao Tong University School of Medicine Department of Gerontology

• Zhang, Zhen: Shanghai Jiao Tong University School of Medicine Department of Gerontology

• Huang, Lin: Shanghai Jiao Tong University School of Medicine Department of Gerontology

• Li, Qinjie: Shanghai Jiao Tong University School of Medicine Department of Gerontology

• Guo, Yin-Han: University of Queensland Faculty of Medicine

• Guo, Qi-Hao: Shanghai Jiao Tong University School of Medicine Department of Gerontology

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching

Commercial Use: No

Fee: No

Test Year: 2023

Reference’s

Cui, L., Zhang, Z., Huang, L., Li, Q., Guo, Y.-H., & Guo, Q.-H. (2023). Dual-stage cognitive assessment: A two-stage screening for cognitive impairment in primary care. BMC Psychiatry, 23(1), Article 368. https://doi.org/10.1186/s12888-023-04883-w

The scale is distributed under the Creative Commons license: creativecommons.org/licenses/by/4.0/

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Items of the Dual-Stage Cognitive Assessment (DuCA)

Part 1 Items (contributing to a total of 10 points):

• Verbal Fluency (two points)

• Visual Perception (three points)

• Delayed Recall (five points)

Part 2 Items (contributing to a total of 28 points):

• Auditory Sentence Memory (six points)

• Category Switching (10 points)

• Visual Memory (12 points)

Additional Items (not contributing to the total score):

• Prospective Memory

• Metamemory

Part 1

Part 2

Bolded font indicates items that count in the total score.