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Assessing Cognitive Impairment in the Health and Retirement Study Harmonized Cognitive Assessment Protocol Project: Comparing a Diagnostic Algorithm With a Diagnostic Consensus Panel
Madeline R. Farron, Lindsay H. Ryan, Jennifer J. Manly, Deborah A. Levine, Brenda L. Plassman, Bruno Giordani, Richard Norman Jones, Kenneth M. Langa. Journal of Aging and Health, 2025-04-15
Topic: Risk, prevention and care in population studies
BackgroundAccurate classification of cognitive impairment in population studies is challenging.ObjectiveTo compare the performance of a diagnostic algorithm with a clinical consensus panel.SampleIn 2016, the Health and Retirement Study (HRS) implemented the Harmonized Cognitive Assessment Protocol Project (HRS-HCAP) to streamline cognitive assessments for select HRS participants.MethodsThe Manly-Jones HCAP diagnostic classification was used to classify cognitive status as normal, mild cognitive impairment (MCI), or dementia. For this analysis, a consensus panel of five clinicians reviewed 50 cases with high diagnostic uncertainty, each reviewing 30 cases, blinded to the algorithm's classifications.AnalysisDiagnostic concordance was assessed using unweighted and weighted Cohen's kappa (κ).ResultsUnweighted concordance was 70% (35/50), with discordance mostly among MCI cases. Weighted concordance was 84%. Unweighted κ was 0.56 (95% CI 0.30-0.81) and weighted κ was 0.75 (95% CI 0.49-0.91), indicating moderate to substantial agreement between the two methods.
Key findings
- BackgroundAccurate classification of cognitive impairment in population studies is challenging.ObjectiveTo compare the performance of a diagnostic algorithm with a clinical consensus panel.SampleIn 2016, the Health and Retirement Study (HRS) implemented the Harmonized Cognitive Assessment Protocol Project (HRS-HCAP) to streamline cognitive assessments for select HRS participants.MethodsThe Manly-Jones HCAP diagnostic classification was used to classify cognitive status as normal, mild cognitive impairment (MCI), or dementia.
- For this analysis, a consensus panel of five clinicians reviewed 50 cases with high diagnostic uncertainty, each reviewing 30 cases, blinded to the algorithm's classifications.AnalysisDiagnostic concordance was assessed using unweighted and weighted Cohen's kappa (κ).ResultsUnweighted concordance was 70% (35/50), with discordance mostly among MCI cases.
- Unweighted κ was 0.56 (95% CI 0.30-0.81) and weighted κ was 0.75 (95% CI 0.49-0.91), indicating moderate to substantial agreement between the two methods.
Why it matters
This study compared a diagnostic algorithm with a clinical consensus panel for classifying cognitive impairment and found moderate to substantial agreement. It is about improving classification methods and does not address treating, curing, or preventing Alzheimer's disease.
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Study details
- Evidence strengthLow
How this study scored 38/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported and studied in people because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Aging and Health) |
| Journal's citation record | 1 / 4 | Journal of Aging and Health: journal h-index 119 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 1 / 2 | Blinded or placebo-controlled (as stated in the record) |
| Times cited | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 1 / 6 | Cited 0.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Kenneth M. Langa: h-index 102 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Michigan: institution h-index 2,240 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 8 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40235076) |
| Free to read | 2 / 2 | Free to read |
| Total | 38 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1177/08982643251335370
- PubMed: 40235076
- Original source →
- Free full text: Journal of Aging and Health →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Farron, M. R., Ryan, L. H., Manly, J. J., Levine, D. A., Plassman, B. L., Giordani, B., et al. (2025). Assessing Cognitive Impairment in the Health and Retirement Study Harmonized Cognitive Assessment Protocol Project: Comparing a Diagnostic Algorithm With a Diagnostic Consensus Panel. Journal of Aging and Health. https://doi.org/10.1177/08982643251335370
Vancouver
Farron MR, Ryan LH, Manly JJ, Levine DA, Plassman BL, Giordani B, et al. Assessing Cognitive Impairment in the Health and Retirement Study Harmonized Cognitive Assessment Protocol Project: Comparing a Diagnostic Algorithm With a Diagnostic Consensus Panel. Journal of Aging and Health. 2025. doi:10.1177/08982643251335370. PMID: 40235076.
BibTeX
@article{farron2025-40235076,
author = {Farron, Madeline R. and Ryan, Lindsay H. and Manly, Jennifer J. and Levine, Deborah A. and Plassman, Brenda L. and Giordani, Bruno and Jones, Richard Norman and Langa, Kenneth M.},
title = {{Assessing Cognitive Impairment in the Health and Retirement Study Harmonized Cognitive Assessment Protocol Project: Comparing a Diagnostic Algorithm With a Diagnostic Consensus Panel}},
journal = {Journal of Aging and Health},
year = {2025},
doi = {10.1177/08982643251335370},
pmid = {40235076},
url = {https://doi.org/10.1177/08982643251335370}
}
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