Attachment 2. Purpose and Development
Recognizing the importance of cognitive decline as a public health issue, the National Center for Chronic Disease Prevention & Health Promotion’s Alzheimer’s Disease and Healthy Aging Program, in collaboration with national experts, developed and implemented an optional module of questions on self-assessed cognitive decline, for states to use on the Behavioral Risk Factor Surveillance System (BRFSS).1 The original 6-question version of the BRFSS Cognitive Decline Optional Module was available to states in 2015-2022 to estimate the prevalence of subjective cognitive decline and related measures. A revised 5-question version of the module was made available to states in 2023. Data from the revised BRFSS module will first be available for public use in the Fall of 2024. Due to the revisions, CDC’s Alzheimer’s Disease Science Team anticipates that the prevalence of subjective cognitive decline and other measures will change. A quantitative split sample study conducted during 2022-2023 supports this assumption. This study showed notable differences in results between the original version of the module and the revised version, but without explanation. The CDC’s Alzheimer’s Disease Science Team require further information to assist in explaining how changes to the module affected the resulting measures used for disease surveillance. A mixed-methods approach to providing this information is proposed using data from cognitive interviews alongside data from a future spilt sample study, supported by web-probing, using CDC’s Research and Development Survey (RANDS).2 (This protocol requests permission for CCQDER to conduct the cognitive testing interviews. A separate protocol will be submitted for the RANDS experimental study.)
One of the key differences between the original and the revised module was the use of an introduction, priming respondents as to what to consider when answering the module of questions. The introduction and its impact on how respondents may answer subsequent questions will form the focus of the cognitive interview probing. Changes to the terminology used in the revised module may also have affected the data and will also be examined, to the extent possible, during the cognitive testing. The cognitive interviews will inform web-probes to be administered during RANDS. Two potential additional questions, intended to give an indication of self-assessed severity and anxiety caused by any self-perceived cognitive decline, are also included for evaluation in this study. These two questions have not been previously fielded or cognitively tested.
Additional information about the original module:
BRFSS Statistical Brief: Cognitive Decline Optional Module, October 2019 (cdc.gov)
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