Challenges in Measuring Applied Cognition: Measurement Properties and Equivalence of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) Applied Cognition Item Bank.
Jeanne A Teresi, Katja Ocepek-Welikson, Marjorie Kleinman and 2 others
PMID 33556349WHAT IT FOUND
Many items in this hospitalized patient cognition test showed bias for age, sex, or education.
Items on reading long books or using smartphones were harder for older or less educated people, regardless of actual cognitive ability. Six items were deleted or restricted to improve the test's fairness.
Key findings
01About one third of the item pool showed differential item functioning (bias) or poor discrimination, particularly related to age and sex.
02Items requiring reading long books or understanding long speeches were more difficult for people with lower education, even when their actual cognitive ability was the same.
03Items related to hearing or modern technology, such as using a smartphone or answering the phone, showed bias against older adults.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample was skewed, with most respondents reporting little or no difficulty, which reduces the test's ability to detect problems in higher-functioning individuals. The study could not analyze bias by race or ethnicity, only by education, age, and sex. Many items were found to be poorly discriminating, meaning they did not effectively distinguish between different levels of cognitive ability. The analysis suggests that some items measuring "cognition" may actually be measuring hearing, vision, or physical frailty.
Declared interests
None declared. The work was supported by the NIH.
The easy way to misread this
Do not assume that a low score on items like "using a smartphone" or "reading a long book" indicates cognitive impairment. The study found these items were biased against older adults and those with lower education levels, even when their actual cognitive ability was equivalent to others. These scores may reflect lack of familiarity or reading difficulty, not functional cognition.