Individuals aged 50 to 85 years who could read/write in English or Spanish were eligible. Detailed step-by-step written and pictorial directions for collecting each of the FITs were provided. 5 Healthy patients scheduled for screening or surveillance colonoscopy were asked to collect stool samples using 5 different FITs from 1 bowel movement. This study used data from our comparative effectiveness study to assess test characteristics of 5 FITs used for detection of advanced colorectal neoplasia, using optical colonoscopy as the gold standard. The purposes of this study were to determine if (1) certain demographic characteristics (potential predictors) of participants, and (2) clock-drawing test results (as a screening test for cognitive impairment) were associated with FIT sample collection errors. Our hypothesis was that impairment demostrated with a clock-drawing test may be associated with errors in FIT sample collection.
In the context of a large comparative effectiveness study of FIT testing, we sought to evaluate the possible contribution of impaired cognition on FIT test completion and errors. 20 Of the 493 respondents from 16 primary care offices across Iowa, 15% had abnormal clock drawings individuals with normal scores had higher accuracy in self-report compared with their medical record. In another study, a mailed questionnaire with a clock-drawing test was used to compare the accuracy of colonoscopy self-report with information from the medical record. The results indicated that for both males and females, the mean total clock scores worsened with each successive 5-year age group. 19 That study demonstrated that community-dwelling persons were able to complete a clock-drawing test by mail.
13– 18 In a mailed survey to determine if a clock-drawing test can be accomplished by mail, 4,843 community-dwelling persons aged 52 or more years, in a southern California retirement community, completed a clock-drawing test scored by 2 methods and found that 510 (11%) respondents had abnormal clock drawings. 11, 12 Studies have demonstrated that individuals with cognitive impairment score worse on the clock-drawing test than individuals with normal cognition. 9, 10Ĭlock-drawing tests are used with batteries of other cognitive tests to discriminate among individuals with normal cognition, mild cognitive impairment, and dementia. 2, 7, 8 An underlying cause for these mistakes may be mild cognitive impairment, major depression, a low education level, or being careless. It may also be due to an inability to consider the sequence of steps to complete the task or visual perception problems. 6 Collecting the stool specimen incorrectly demonstrates failure in executive function, since collection involves reading, understanding, and following instructions. 5 Forgetting to return a specimen or provide the date of stool collection are tasks in which the participant forgets to do something, possibly due to short-term memory loss or inattention. Mistakes made in our study, comparing the effectiveness of FITs with colonoscopy, included reporting an incorrect date, not including the date of the stool sample collection, or collecting the stool sample incorrectly. 4 Both require the ability to correctly follow a sequence of steps.ĭuring a research study, patients can make mistakes that may be considered careless (eg, not answering a question on a survey). 1, 3 Screening for colorectal cancer, which is recommended to start at age 45 years, can be accomplished by several methods including a fecal immunochemical test (FIT) or colonoscopy. 2 Individuals with mild cognitive impairment demonstrate impairment in any cognitive domain, such as memory, executive function, language, or visuospatial skills. 1 Mild cognitive impairment is described as an intermediate state between cognitively intact persons and those with dementia. Approximately 16% to 20% of people ages 60 or more years have mild cognitive impairment.
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