Development of a unidimensional composite measure of neuropsychological functioning in older cardiac surgery patients with good measurement precision

Abstract

The objective of this analysis was to develop a measure of neuropsychological performance for cardiac surgery and to assess its psychometric properties. Older patients (n = 210) underwent a neuropsychological battery using nine assessments. The number of factors was identified with variable reduction methods. Factor analysis methods based on item response theory were used to evaluate the measure. Modified parallel analysis supported a single factor, and the battery formed an internally consistent set (coefficient alpha = .82). The developed measure provided a reliable, continuous measure (reliability > .90) across a broad range of performance (–1.5 SDs to +1.0 SDs) with minimal ceiling and floor effects.

Keywords:

• Cognition
• Cardiac surgery
• Aged
• Item response theory
• Neuropsychology

Acknowledgments

The first two authors contributed equally to this work and agreed to share first authorship. The authors acknowledge the contributions of David Alsop to this paper. The authors report no financial conflict of interest. This work was funded by the Harvard Older Americans Independence Center AG08812–14 (E.R.M., R.N.J.), R03 AG029861 (J.L.R.), K24 AG00949 (S.K.I.), R21AG025193 (S.K.I.), R21 AG027549 (E.R.M.), R21 AG026566 (E.R.M.), R01 AG 030618 (E.R.M.), and R03 AG028189 (E.R.M.). J. L. Rudolph is supported by a VA (U.S. Department of Veterans Affairs) Rehabilitation Career Development Award. S. K. Inouye is supported by the Milton and Shirley F. Levy Family Chair.