ویژگی‏‎های روان‌سنجی پرسش‌نامه کوتاه وضعیت شناختی دستی سالمندان

Aging is associated with significant changes in cognitive abilities, however, the lack of a suitable and short measure in Iran to assess the cognitive status of older adults is evident. Therefore, this study was conducted with the aim of investigating the validity and reliability of short portable mental status questionnaire for older adults. The statistical population of this research included all people over 65 years old living in Arak, Iran in 2019, among whom 240 older adults (128 men and 124 women) were selected using convenience sampling method. To collect data, Pfeiffer et al.’s short portable mental status questionnair (SPMSQ) and Wechsler memory scale (form I) were used. Descriptive statistics as well as confirmatory factor analysis (CFA) were used to analyze the data in SPSS-26 and AMOS-24 software. The results of data analysis figured out that the internal reliability according to Cronbach’s alpha was 0.76. In order to check the validity of the questionnaire, CFA and convergent validity were used, and the results of the CFA indicate the desired validity of the questionnaire. Morover, the Pearson’s correlation coefficient indicated that there is a significant relationship between the people’s scores in mental status questionnaire and their scores in Wechsler memory subscales, as such the correlation coefficient between the mental status score and the memory score obtained to be 0.71. The results indicated that SPMSQ has a good reliability and validity coefficient. Therefore, based on the results of the current study, clinical experts are suggested to use SPMSQ to diagnose the cognitive impairment in older adults.
EXTENDED ABSTRACT
 Introduction
Aging is considered a critical stage in human psychological development, characterized by significant changes and degeneration in various bodily systems. Age-related changes lead to a marked decline in cognitive functions among older adults, which has a pronounced negative impact on their quality of life. Age-related cognitive decline and executive dysfunction are multifactorial phenomena that are crucial neuropsychological aspects of aging, requiring effective and early recognition and intervention. One reason for developing new measures to assess brain structure disorders in older adults is that existing tools are not specifically designed for use in older patients or standardized for the older population. These tools are often too complex for many old patients to complete. Among the short tests to measure cognitive function in older adults, Pfeiffer's short portable mental status questionnaire (SPMSQ) can be mentioned. In developing this 10-question questionnaire, at least five objectives were pursued: 1) Assessing various aspects of cognitive function, including short-term memory, long-term memory, orientation to the environment, information about current events, and the ability to perform sequential mathematical tasks; 2) Being brief and portable; 3) Ease of scoring; 4) Covering the full spectrum of cognitive function from healthy performance to severe impairment, making it usable for both the general population and clinical settings; and 5) Measuring the impact of basic demographic factors. Given the relative advantages of this tool and the lack of suitable short tools compatible with the cultural and local context of Iran, and the necessity of assessing the cognitive status of older adults, considering the high treatment costs, the present study aims to examine the validity and reliability of the Short Mental Status Questionnaire for older adults.
Method
This was a correlational study, of confirmatory factor analysis type. The statistical population included all older adults over 65 years old residing in Arak, Iran in 2019. From this population, 240 individuals (128 men and 112 women) were selected using convenience sampling. The inclusion criteria were: (1) a minimum age of 65 years, (2) sufficient hearing and speaking ability to interact regarding the study and questionnaire, and (3) consent to participate in the study. The exclusion criteria included: (1) the presence of acute cognitive disorders such as Alzheimer’s and dementia, and (2) the use of psychiatric medications due to psychological problems. Participants responded to SPMSQ and the Wechsler Memory Scale Form Ι. Initially, SPMSQ was translated by two language experts and reviewed by two other English language experts. The questionnaire was then evaluated for face and content validity and made available to 358 older adults over 65 years old. Out of the questionnaires completed, 240 responses were included in the analysis, and 118 responses were excluded due to incompleteness. Finally, the data obtained from the questionnaires were statistically analyzed using confirmatory factor analysis in SPSS-26 and Amos-24 software.
 Results
To assess the construct validity of the Short Portable Mental Status Questionnaire, confirmatory factor analysis and convergent validity were employed, the result of which can be seen in Figure 1.
Based on Figure 1, the calculated factor loadings, which indicate the correlation between observed and latent variables, are greater than 0.4. This suggests that the variance between the construct and its indicator is greater than the measurement error variance of that construct, indicating acceptable reliability for the measurement model. Moreover, the normalized chi-square measure (X2/df), CFI, AGFI, GFI, NFI, NNFI, and RMSEA for the short portable mental status questionnaire are 1.32, 0.93, 0.94, 0.90, 0.91, 0.93, and 0.04, respectively. therefore, the short portable mental status questionnaire aligns with the established criteria for appropriate values of fit indices. Therefore, all factor loadings in the confirmatory factor analysis model of the Short Portable Mental Status Questionnaire were found to be significant. To assess the convergent validity of the Short Portable Mental Status Questionnaire, its correlation with the Wechsler Memory Scale scores was calculated. The scale demonstrated good convergent validity, with a correlation coefficient of 0.71 between the total Wechsler Memory Scale score and the Short Portable Mental Status Questionnaire. To evaluate the reliability of the data collected using the Short Portable Mental Status Questionnaire, both internal consistency and test-retest methods were employed. The results showed that the overall reliability of the test was 0.76, indicating that the Short Portable Mental Status Questionnaire has satisfactory reliability. Additionally, to assess the test-retest reliability, the Short Portable Mental Status Questionnaire was administered to 30 respondents with a two-week interval, yielding a coefficient of 0.68, confirming the test-retest reliability of the questionnaire.
Conclusion
In the older population, cognitive changes are common and can manifest as normal cognitive aging, mild cognitive impairment, or Alzheimer’s disease. Daily activities require cognitive abilities, and deficits in these abilities can lead to adverse outcomes and significantly reduce the quality of life. These deficits can be assessed through a thorough examination of cognitive abilities. Developing various tools to measure cognitive health in this age group appears essential. The results indicated that the Short Cognitive Status Questionnaire for older adults has good validity and reliability among Iranian older adults. The obtained Cronbach’s alpha coefficient was 0.76, indicating appropriate reliability. Additionally, the questionnaire demonstrated adequate test-retest reliability, with a coefficient of 0.68, reflecting suitable reliability. Furthermore, the findings showed that the Short Cognitive Status Questionnaire for older adults possesses necessary convergent validity. The correlation coefficient between this questionnaire and the Wechsler Memory Scale was 0.71, thus confirming its convergent validity.
Ethical Consideration
Ethical Code
To adhere to ethical standards in research, this study was registered at the Islamic Azad University, Arak branch.
Financial Support
 This study had no financial support
Authors’ Contributions

A: Conceptualization, methodology, writing-original draft; H. D: Software, formal analyses, writing-review & editing; E. D: Data curation, project administration

Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
Respectful appreciation is extended to the esteemed older participants for their cooperation and assistance in completing the questionnaires.
References
Agapoff IV, J. R., Maixner, S., Takeshita, J., Nikogosyan, G., & Kirwin, P. (2022). A survey of geriatric psychiatry fellows and program directors: specialty choice, program choice, and program quality. Academic Psychiatry, 46(4), 455-459. https://doi.org/10.1007/s40596-022- 01611-6
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Washington, DC: American Psychiatric Publishing.
Bu, Z., Huang, A., Xue, M., Li, Q., Bai, Y., & Xu, G. (2021). Cognitive frailty as a predictor of adverse outcomes among older adults: A Systematic review and meta-analysis. Brain and behavior, 11(1), e01926. https://doi.org/10.1002/brb3.1926
Chen, F. T., Etnier, J. L., Chan, K. H., Chiu, P. K., Hung, T. M., & Chang, Y. K. (2020). Effects of Exercise Training Interventions on Executive Function in Older Adults: A Systematic Review and Meta-Analysis. Sports Medicine, 50(8), 1451–1467. https://doi.org/10.1007/s40279-020-01292-x
Faghfouriazar, M. (2023). The Effectiveness of Selected Perceptual-Motor Exercises on Working Memory and Quality of Life of Elderly Women. Aging Psychology, 9(3), 310-293. https://doi.org/ 10.22126/jap.2023.9426.1719 [Persian]
Fleiss, J. L. (2011). Design and analysis of clinical experiments. John Wiley & Sons.
Fu, P., Zhou, C., & Meng, Q. (2020). Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress. International Journal of Environmental Research and Public Health, 17(14), 5240. https://doi.org/10.3390/ijerph17145240
Hajigadirzadeh, A., Taheri, A., & Babakhani, N. (2023). The Comparison of the effectiveness of cognitive rehabilitation and compassion-based therapy on the cognitive flexibility of the elderly with mild cognitive impairment. Aging Psychology, 9(1), 61-77. [Persian]
Huang, Q., Zhao, J., Jiang, W., & Wang, W. (2022). The Association between Physical Activity and Cognitive Function: Data from the China Health and Nutrition Survey. Behavioural Neurology,1, Article 3438078. https://doi.org/10.1155/2022/3438078
Iran Statistics Center. (2015). Studying the situation of the elderly in Iran, Tehran: Publications of Iran Statistics Center. [Persian]
Karimi Lichahi, R., Azarian, A., & Akbari, B. (2019). The Effectiveness of Play Therapy on Reading Performance, Adaptive Skills and Behavioral Problems in Students with Dyslexia. Journal of Child Mental Health, 6 (3), 200-214. [Persian]
Kraus, D. R., Castonguay, L., Boswell, J. F., Nordberg, S., S., & Hayes, J. A. (2011). Therapist effectiveness: Implications for accountability and patient care. Psychotherapy Research, 21(3),267-276. https://doi.org/10.1080/10503307.2011.563249
Lambert, M. J. & Hawkins, R. J. (2004). Measuring outcome in professional practice: Considerations in selecting brief outcome measures. professional psychology: Research and practice,35(5), 492-499. https://doi.org/10.1037/0735-7028.35.5.492 
Lesher, E. L., & Whelihan, W. M. (1986). Reliability of mental status instruments administered to nursing home residents. Journal of Consulting and Clinical Psychology, 54(5), 726-727. https://doi.org/10. 1037//0022-006x. 54. 5. 726
Lin, M., Ma, C., Zhu, J., Gao, J., Huang, L., Huang, J., Liu, Z., Tao, J., & Chen, L. (2022). Effects of exercise interventions on executive function in old adults with mild cognitive impairment: A Systematic review and meta-analysis of randomizedcontrolled trials. Ageing Research Reviews, 82, 101776. https://doi.org/10.1016/j.arr.2022.101776
Mantovani, E., Zucchella, C., Schena, F., Romanelli, M. G., Venturelli, M., & Tamburin, S. (2020). Towards a Redefinition of Cognitive Frailty. Journal of Alzheimer's Disease, 76(3), 831–843. https://doi.org/10.3233/JAD-200137
Maruish, M.E. (Ed.). (2014). The Use of Psychological Testing for Treatment Planning and Outcomes Assessment. Instruments for Adults, 3(3). https://doi.org/ 10.4324/9781410610614
Masuda, C., Aggarwal, L., Bray, M. L., Cheung, C. K., Kim, B. J., Wen, A., Okamoto, L., Uechi, M., Lee, Y. J., & Masaki, K. (2022). Preventive Care and Outcomes of Interprofessional Medicare Annual Wellness Visits for Older Adults. International journal of environmental research and public health, 19(24), 16752. https://doi.org/10.3390/ijerph192416752
Matheson, G. J. (2019). We need to talk about reliability: making better use of test-retest studies for study design and interpretation. PeerJ, 7, Article 6918. https://doi.org/10.7717/peerj.6918. PMID: 31179173
Mello, B. H., Lenardt, M. H., Moraes, D. C., Setoguchi, L. S., Seima, M. D., & Betiolli, S. E. (2021). Cognitive impairment and physical frailty in older adults in secondary health care. Revista Da Escola De Enfermagem Da Usp, 55, Article 03687. https://doi.org/10.1590/S1980-220X2019029803687
Movahhedi, Y., Khodadadi, M., & Mohammadzadegan, R. (2014). The comparison cognitive function and theory of mind in people with symptoms of obsessive - compulsive disorder and normal people. Journal of Cognitive Psychology; 2 (3), 28-36. [Persian]
Nejati, V. (2013). Cognitive abilities questionnaire: Development and evaluation of psychometric properties. Advances in Cognitive Science, 15(2), 11-15. [Persian]
Nosrati, P., Momeni, K., & Wahl, H. (2022). Testing the Psychometric Properties of the Awareness of Age-Related Changes Questionnaire in a Sample of the Community-Dwelling Elderly in Iran. Aging Psychology, 8(2), 133-119. https://doi.org/10.22126/jap.2022.7125.1579
Pfeiffer, E A. (1975). Short portable mental status questionnaire for the assessment of organic brain deficit in elderly patient. Journal of the American Geriatrics Society, 23(10): 433-4. 41.  https://doi.org/ 10. 1111/j. 1532-5415. 1975. tb00927.
Podda, J., Tacchino, A., Pedullà, L., Monti Bragadin, M., Battaglia, M. A., & Brichetto, G. (2022). Focus on neglected features of cognitive rehabilitation in MS: Setting and mode of the treatment. Multiple Sclerosis Journal, 28(7), 1009-1019. https://doi.org/10.1177/1352458520966 300
Rockwood, K. (2016). What can we expect of health in old age? The Lancet, 387 (10020), 730–731. https://doi.org/10.1016/S0140-6736 (15)01022-3
Ryan, J. J., Morris, J., Yaffa, S., & Peterson, L. (1981). Test-retest reliability of the Wechsler Memory Scale, Form I. Journal of Clinical Psychology, 37(4), 847–848.
Shahabi, R. (2019). Normal cognitive aging: age related cognitive changes in elderly. Aging Psychology, 5(2), 101-116. https://doi.org/10.22126/JAP.1970.117 9 [Persian]
Shultz, J. M., Aman, M. G., & Rojahn, J. (1998). Psychometric evaluation of a measure of cognitive decline in elderly people with mental retardation. Research In Developmental Disabilities, 19(1), 63-71. https://doi.org/10.1016/s0891-4222(97)00029-2
Sojoodi, A., Niazi, M., & Farhadian, A. (2022). Designing a Model on Quality-of-Life Components for the Elderly based on Social Changes in Iran. Journal of Social Continuity and Change, 1(1), 185-200. [Persian]
Sugimoto, T., Arai, H., & Sakurai, T. (2022). An update on cognitive frailty: Its definition, impact, associated factors and underlying mechanisms, and interventions. Geriatrics & Gerontology International, 22(2), 99–109. https://doi.org/10.1111/ggi.14322
United Nations. (2019). World Population Ageing 2019: Highlights.
Wechsler, D. (1945). A Standardized memory scale for clinical use. The Journal of Psychology, 19(1), 87–95. https://doi.org/10.1080/00223980.1945.9917223
World Health Organization. (2011). Global Health and Aging [Internet]. National. Institute on Aging National Institutes of Health; Available from: https:// www. who. int/ ageing/ publication / global_ health. Pdf
Yuan, Y., Lapane, K. L., Tjia, J., Baek, J., Liu, S. H., & Ulbricht, C. M. (2021). Physical Frailty and Cognitive Impairment in Older Adults in United States Nursing Homes. Dementia and geriatric cognitive disorders, 50(1), 60–67. https://doi.org/10.1159/000515140
Yazdanbakhsh, K. (2016). Effects of life review on social adjustment of retirees’ elderly persons. Aging Psychology, 1 (3), 179–185. [Persian]