Measuring Change in Everyday Cognition: Development and Initial Validation of the Cognitive Change Checklist (3CL)

Objective: There is ample evidence to support an informant-based approach in screening efforts for the identification of cases of Mild Cognitive Impairment and early Alzheimer disease, but existing instruments are not maximally designed to capture recent changes in cognitive status of the types seen in these disorders. The authors describe the construction of a multiscale informant rating checklist (Cognitive Change Checklist; 3CL) designed to be sensitive to the earliest stages of cognitive decline associated with degenerative dementias. Design: Scale development, reliability, and validity study. Setting: Memory Disorder Clinics. Participants: Three hundred fifty-nine individuals are evaluated for a memory disorder. Results: The analyses resulted in a 28-item informant rating checklist of cognitive change that is composed of four nonoverlapping scales titled Memory, Executive, Language, and Remote Recall. Scale reliabilities were found to be well within guidelines to support their use in the clinical assessment of change in global cognition and specific cognitive domains. Substantive support for the validity of the checklist was obtained from correlational analyses that showed significant scale relationships with neuro-cognitive measures, from the finding of differences in scale scores among diagnostic groups that paralleled that of the neurocognitive measures, and from examination of the sensitivity of the scales in receiver operating characteristic analyses. Conclusion: These findings provide support for the use of the checklist as a clinical tool to facilitate identification of cases of Mild Cognitive Impairment and early Alzheimer disease. Further examination of the diagnostic utility of the scale, and of its value in combination with cognitive screening measures, will also be required. (Am J Geriatr Psychiatry 2009; 17:516-525)