Cognitive Assessment Of Older Adults Research Articles

Reliability of Telephone and Videoconference Methods of Cognitive Assessment in Older Adults with and without Dementia.

Telephone and videoconference administration of cognitive tests introduce additional sources of variance compared to in-person testing. Reviews of test-retest reliability have included mixed neurocognitive and psychiatric populations with limited consideration of methodological and statistical contributions. We reviewed reliability estimates from comparison studies of older adults with and without dementia, considering test-retest analyses and study methods. Medline, Embase, PsycINFO, and Web of Science were systematically searched from 1 January 2000 to 9 June 2020 for original articles comparing telephone or videoconference administered cognitive instruments to in-person administration in older adults with and without dementia or mild cognitive impairment. Of 4,125 articles, 23 were included: 11 telephone (N = 2 dementia cohorts) and 12 videoconference (N = 4 dementia cohorts). Telephone administered subtest scores trended in the same direction as in-person with comparable means. Person-level data were scarce. Data on dementia was only available for MMSE, with resulting subtle modality bias. MMSE, SMMSE, Letter Fluency, and HVLT-R in healthy to mild-moderate Alzheimer's disease were particularly reliable for videoconference administration. Other tests show promise but require more observations and comprehensive analyses. Most studies used high-speed stable videoconferencing hardware resulting in a lack of ecological validity for home administration. Remote administration is often consistent with in-person administration but variable and limited at the person/test level. Improved statistical design and inclusion of dementia related cohorts in telephone studies is recommended. Reliability evidence is stronger for videoconferencing but with limited applicability to home administration and severe dementia. Improved reporting of administrative procedures is recommended.

Relationships Between Cognitive Impairment and Self-Management in Older Adults With Type 2 Diabetes: An Integrative Review.

Cognitive impairment is common in older adults with diabetes and is likely to negatively affect their daily diabetes self-management behaviors (DSMB). The primary aim of this integrative review was to summarize and synthesize the current state of knowledge about relationships between cognitive impairment and DSMB in older adults with type 2 diabetes. The review was guided by Whittemore and Knafl's 2005 framework, and study quality was evaluated using the Crowe Critical Appraisal Tool. Of 27 studies reviewed, 24 were quantitative, and three were qualitative. Heterogeneity was noted in study design, participant characteristics, and measures of cognitive function and DSMB. Overall, global cognitive impairment and executive function impairment related particularly to poor medication management and glucose self-monitoring. The findings supported the need for routine cognitive assessment of older adults with diabetes, but more longitudinal and interventional studies are needed to better define cognitive impairment-DSMB relationships. [Research in Gerontological Nursing, 14(2), 104-112.].

A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults.

Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. In this cross-sectional study, 146 participants (cognitively healthy = 53, mild cognitive impairment (MCI) = 46, dementia = 47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. The BHA had an AUC of 0.95 (95% CI: 0.91-0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90-0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.

Preliminary study of the validity and reliability of the Chinese version of the Saint Louis University Mental Status Examination (SLUMS) in detecting cognitive impairment in patients with traumatic brain injury

The Saint Louis University Mental Status Examination (SLUMS) has been shown to be useful in the cognitive assessment in older adults and patients with dementia. The aim of this study was to preliminarily explore the effectiveness of the Chinese version of the SLUMS in the detection of cognitive impairment in patients with traumatic brain injury (TBI) and to provide an objective basis for its clinical application in China. In this cross-sectional study, 42 patients with TBI and 30 matched normal controls were administered. Participants were assessed by the Chinese version of the Mini-Mental State Assessment scale (MMSE), Montreal Cognitive Assessment scale (MoCA) and SLUMS. Results showed that the Chinese version of the SLUMS had satisfactory internal consistency (Cronbach's α coefficient: 0.723), excellent interrater reliability (ICC: 0.990–0.998) and intrarater reliability (ICC: 0.968), as well as good validity. In the TBI group, the total SLUMS score was moderately positively correlated with the MMSE score (r = 0.702, p = .000) and highly positively correlated with the MoCA score (r = 0.831, p = .000). Receiver Operating Characteristic (ROC) curve analyses showed that the area under the curve (AUC) of the SLUMS, MMSE and MoCA were 0.872, 0.756 and 0.916, respectively. The optimal cutoff score of 22.5 or fewer points are suggested for the SLUMS to discriminate cognitive impairment, with a sensitivity of 0.844 and a specificity of 0.825. The Chinese version of the SLUMS has excellent reliability and validity, and can be used as a screening tool for cognitive impairment of patients with TBI in China.

Validity and reliability of hindi translated version of Montreal cognitive assessment in older adults.

To evaluate the validity and reliability of Hindi version of Montreal cognitive assessment (H-MoCA) as a screening tool to detect mild cognitive impairment among older adults of India. The study was conducted in three phases, namely content validation of H-MoCA reliability estimation, internal consistency and test- retest reliability. Qualitative and quantitative validation through expert review resulted in modification of H-MoCA which was tested on purposive sample of 30 subjects, and analysis was done for internal consistency reliability, then the scale was re-administered to the same group to establish test-retest reliability. Internal consistency was reported in terms of Cronbach's alpha (α) and test-retest reliability in terms of intra class correlation coefficient (ICC). Qualitative review and Content validation ratio (Lawshe) validate the content of H-MoCA with CVR of 0.99. The scale has good internal consistency, Cronbach's alpha (α) = 0.64 and high test-retest reliability, intra class correlation coefficient (ICC) = 0.87. Thus the Hindi translated version of MoCA is a valid and reliable tool for detecting mild cognitive impairment.

Triple Test Plus Rapid Cognitive Screening Test: A Combination of Clinical Signs and A Tool for Cognitive Assessment in Older Adults

Less time-consuming, easy-to-apply and more reliable cognitive screening tests are essential for use in primary care. The aim of this study was to investigate the diagnostic value of the Turkish version of the Rapid Cognitive Screen (RCS-T) and Triple Test individually and the combination of RCS-T with each sign and Triple Test to screen elderly patients for cognitive impairment (CI). A total of 357 outpatients aged 60 or older, who underwent comprehensive geriatric assessment, were included in the study. Presence or absence of attended alone sign (AAS), head-turning sign, and applause sign was investigated. The mean age of the patients was 74.29 ± 7.46. Of those, 61 patients (28 men, 33 women) had Alzheimer’s disease (AD), 59 patients had mild cognitive impairment (MCI) (29 men, 30 women), and 237 (80 men, 157 women) were cognitively robust. The sensitivity of the combination of RCS-T and negative for AAS for CI, AD and MCI is 0.79, 0.86 and 0.61, respectively; the specificity was 0.92, 0.93 and 0.92, respectively; and the positive and negative predictive values revealed good diagnostic accuracy. The combination of RCS-T and negative for AAS is a simple, effective and rapid way to identify possible CI in older adults.

Mobile Technology for Cognitive Assessment of Older Adults: A Scoping Review.

Background and ObjectivesThe number of people diagnosed with dementia is rising appreciably as the population ages. In an effort to improve outcomes, many have called for facilitating early detection of cognitive decline. Increased use of mobile technology by older adults provides the opportunity to deliver convenient, cost-effective assessments for earlier detection of cognitive impairment. This article presents a review of the literature on how mobile platforms—smartphones and tablets—are being used for cognitive assessment of older adults along with benefits and opportunities associated with using mobile platforms for cognitive assessment.Research Design and MethodsWe searched MEDLINE, Web of Science, PsycInfo, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials in October 2018. This search returned 7,024 articles. After removing 1,464 duplicates, we screened titles and abstracts then screened full-text for those articles meeting inclusion and exclusion criteria.ResultsTwenty-nine articles met our inclusion criteria and were categorized into 3 groups as follows: (a) mobile versions of existing article or computerized neuropsychological tests; (b) new cognitive tests developed specifically for mobile platforms; and (c) the use of new types of data for cognitive assessment. This scoping review confirms the considerable potential of mobile assessment.Discussion and ImplicationsMobile technologies facilitate repeated and continuous assessment and support unobtrusive collection of auxiliary behavioral markers of cognitive impairment, thus allowing users to view trends and detect acute changes that have traditionally been difficult to identify. Opportunities include using new mobile sensors and wearable devices, improving reliability and validity of mobile assessments, determining appropriate clinical use of mobile assessment information, and incorporating person-centered assessment principles and digital phenotyping.

Trajectory and Variability Characterization of the Montreal Cognitive Assessment in Older Adults (P5.187)

Trajectory and Variability Characterization of the Montreal Cognitive Assessment in Older Adults (P5.187)

That's Inappropriate! Social Norms in an Older Population-based Cohort.

Social cognition is not routinely assessed in older adults. We report population-based normative data on the Social Norms Questionnaire (SNQ22) which asks individuals about the appropriateness of specific behaviors in hypothetical scenarios, errors being related either to breaking with norms or to over-adhering to perceived norms. Total SNQ scores represent the number of correct responses while subscale scores are error totals. We administered the SNQ22 to 744 adults aged 65+ within a population-based study, and examined the distribution of scores by demographics, other cognitive measures, and Clinical Dementia Rating (CDR). Most participants performed well with few errors. Women and young-old individuals performed significantly better than men and older individuals on total score and over-adherence; women had fewer break-norms errors than men. No race or education effects were observed. Worse (higher) total scores and (lower) over-adherence errors were inversely associated with literacy, CDR, Mini-Mental State Examination, attention, memory, language, executive, and visuospatial domains. Break-norms errors were rare and not associated with any of the above. In population-based normative data on the SNQ22. age and sex influenced total score and over-adherence errors, which showed the expected associations with CDR and other cognitive domains. Social norms screening may be useful in the cognitive assessment of older adults.

Cognitive assessment of older adults in general practice: the collateral history.

The collateral (or informant) history is a key component in the assessment of older adults presenting with a memory problem or concern over cognition. Despite this, it rarely features in medical literature and academic curricula. Its role in general practice has never been assessed. The aim of this study is to assess the role of the collateral history in the investigation of cognitive impairment in general practice. An online survey distributed to three nationally representative cohorts of GPs in Ireland (n = 692). Ninety-five (14%; 52.2% male) responded. Nearly all (87%; 83/95) indicate that it is most often a family member who brings possible cognitive impairment to the attention of their GP. The vast majority obtain a collateral history in > 90% of cases (72.6%; 69/95) and rate it very useful in their clinical assessment of cognition. GPs report the collateral history as readily available and rarely refused, with the general practice environment well-suited to obtaining collateral histories. A small minority routinely use the GPCOG informant section (3.2%; 3/95). Nearly all (92.6%; 88/95) report having received no training in obtaining collateral histories with most (79%; 75/95) welcoming of further training in this area. Despite recognition of the utility and importance of the collateral history, the vast majority of GPs report having never received training in obtaining one and do not use structured tools to guide their interview. Further emphasis on the informant history as a distinct clinical entity on medical curricula and increasing emphasis on the availability of structured informant tools are warranted.

Trajectory and variability characterization of the Montreal cognitive assessment in older adults.

The Montreal cognitive assessment (MoCA) has become one of the most widely used cognitive screening instruments since its initial publication. To date, only a handful of studies have explored longitudinal characteristics of the MoCA. The aim of this study is to characterize the trajectory of MoCA performance across a broad age continuum of older adults. Data from 467 cognitively normal participants were used in this analysis. The sample was grouped into four strata based on the participants' age at baseline (60-69, 70-79, 80-89, and 90-99). Mixed model repeated measures (MMRM) analysis and mixed-effects spline models were used to characterize the trajectory of MoCA scores in each age stratum and in the entire sample. Intrasubject standard deviation (ISD) was used to characterize the natural variability of individual MoCA performance over time. The ISD values for each of the age strata indicated that year-to-year individual variation on the MoCA ranged from zero to three points. MMRM analysis showed that the 60-69 stratum remained relatively stable over time while the 70-79 and 80-89 strata both showed notable decline relative to baseline performance. The mixed-effects spline model showed that MoCA performance declines linearly across the older adult age span. Among cognitively normal older adults MoCA performance remains relatively stable over time, however across the older adult age-span MoCA performance declines in a linear fashion. These results will help clinicians better understand the normal course of MoCA change in older adults while researchers may use these results to inform sample size estimates for intervention studies. This study provides an enhanced view of the MoCA's intraindividual trajectory in normal elderly aged 60 and older.

Feasibility of Using a Game-Based Cognitive Assessment for Older Adults in Emergency Care

Background: Developed nations are currently facing a demographic shift towards a higher proportion of elderly people and increasing age-related health concerns. Elderly adults often enter into the health care system through emergency services. As a result, emergency departments (EDs) are an opportune environment for cognitive screening to improve patient outcomes. Existing methods are not designed for use in EDs and require administration by a trained test administrator. As an alternative, we suggest serious games as screening tools that can be self-administered or used with minimal assistance in emergency care. The use of validated and reliable serious games can encourage more efficient and engaging cognitive screening. Objective: Our objective was to investigate the feasibility and usability issues identified in the process of evaluating the validity and reliability of a game-based cognitive screening tool administered on an interactive tablet, for use by elderly adults in emergency care. Methods: We carried out a study in a hospital ED to evaluate the validity of the serious game with elderly adults over the age of 70 years (N=146). Validity was assessed in terms of the correlation of game performance with outcomes of current assessment methods. Comparative assessments included the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM). We also assessed the reliability of our game-based assessment tool in a hospital ED for a large subset of the patients who underwent a revised protocol involving follow-up sessions at a minimum of every 8 hours (n=127). In both studies, research personnel (RP) administered the standard cognitive assessments and then asked the patients to play the serious game. Recruitment for the reliability study overlapped with our validation study, with 56 potential overlap cases. Results: In our validation group, 141 of 146 patients consented to play the serious game. Performance on the serious game correlated significantly with the MoCA (r=–0.339, P<.001), MMSE (r=–0.558, P<.001), CAM (r=0.565, P<.001), and other cognitive assessments. In our reliability study of 127 adults, we obtained data from 126 people. We observed good test-retest reliability with Pearson correlation r values between 0.5 and 0.7. These results supplement findings from our validation study that the assessment was correlated with MMSE, MoCA, and CAM scores. Usability feedback suggested that the game was too easy and the need to use a stylus for users with dry skin. All patients were able to play the serious game administered on a tablet either independently or with minimal assistance from RP. In the latter case, RP would assist by holding the tablet as some patients found it heavy. Conclusions: This research demonstrates the feasibility, validity, and reliability of using a game-based cognitive assessment in a clinical setting. Elderly users in an ED can use our screening tool by improving on the usability of the system by incorporating their feedback in our design process. This research shows that appropriately designed serious games can be self-administered or used with minimal assistance in a clinical setting repeatedly for each person. [iproc 2016;2(1):e35]

Using Your Digital Phenotype to Improve Your Mental Health

Cyberpsychology, Behavior, and Social NetworkingVol. 19, No. 7 EditorialUsing Your Digital Phenotype to Improve Your Mental HealthBrenda K. WiederholdBrenda K. WiederholdSearch for more papers by this authorPublished Online:18 Jul 2016https://doi.org/10.1089/cyber.2016.29039.bkwAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Using Your Digital Phenotype to Improve Your Mental Health." Cyberpsychology, Behavior, and Social Networking, 19(7), p. 419FiguresReferencesRelatedDetailsCited byExploring the digital footprint of depression: a PRISMA systematic literature review of the empirical evidence22 June 2022 | BMC Psychiatry, Vol. 22, No. 1Mobile Technology for Cognitive Assessment of Older Adults: A Scoping Review1 January 2019 | Innovation in Aging, Vol. 3, No. 1 Volume 19Issue 7Jul 2016 InformationCopyright 2016, Mary Ann Liebert, Inc.To cite this article:Brenda K. Wiederhold.Using Your Digital Phenotype to Improve Your Mental Health.Cyberpsychology, Behavior, and Social Networking.Jul 2016.419-419.http://doi.org/10.1089/cyber.2016.29039.bkwPublished in Volume: 19 Issue 7: July 18, 2016PDF download

Cognitive assessment of older adults at the acute care interface: the informant history

Purpose of the studyAn informant history is critical in the complete cognitive assessments of older adults, but has never been formally assessed.Study designA convenience sample of older adults aged ≥70...

Development and Feasibility of a Virtual Reality Task for the Cognitive Assessment of Older Adults: The ECO-VR.

Cognitive assessment with virtual reality (VR) may have superior ecological validity for older adults compared to traditional pencil-and-paper cognitive assessment. However, few studies have reported the development of VR tasks. The aim of this study was to present the development, feasibility, content validity, and preliminary evidence of construct validity of an ecological task of cognitive assessment for older adults in VR (ECO-VR). The tasks were prepared based on theoretical and clinical backgrounds. We had 29 non-expert judges identify virtual visual stimuli and three-dimensional scenarios, and five expert judges assisted with content analysis and developing instructions. Finally, six older persons participated in three pilot studies and thirty older persons participated in the preliminary study to identify construct validity evidence. Data were analyzed by descriptive statistics and partial correlation. Target stimuli and three-dimensional scenarios were judged adequate and the content analysis demonstrated that ECO-VR evaluates temporo-spatial orientation, memory, language and executive functioning. We made significant changes to the instructions after the pilot studies to increase comprehensibility and reduce the completion time. The total score of ECO-VR was positively correlated mainly with performance in executive function (r = .172, p < .05) and memory tests (r = .488, p ≤ .01). The ECO-VR demonstrated feasibility for cognitive assessment in older adults, as well as content and construct validity evidences.

Annual Cognitive Assessment for Older Adults: Update for Nurses

Alzheimer’s disease is predicted to bankrupt Medicare by 2050 if current trends in disease prevalence do not change (Alzheimer’s Association, 2012). Earlier diagnosis and access to health care for Alzheimer’s disease result in decreased health care costs (Brosch & Matthews, 2014). Consequently, in January 2011 screening for cognitive impairment became a component of the annual wellness visit (AWV) outlined in the Patient Protection and Affordable Care Act. Many community health nurses are unaware of this benefit. This article includes a review of the updated 2011 definition of Alzheimer’s disease, the components of the AWV, and tools for conducting cognitive assessment.

Longitudinal Change in Performance on the Montreal Cognitive Assessment in Older Adults

Objective: The Montreal Cognitive Assessment (MoCA) is a brief screening measure commonly used to determine cognitive status among older adults. Despite the popularity of the MoCA, there has been little research into how performance on the MoCA changes over time in healthy older adults. Methods: The present study examined a sample of older adults (n = 53) recruited for a longitudinal study of healthy aging. Change in total MoCA score at three time points (baseline, 12 months, and 48 months) and scores from the Repeatable Battery for the Assessment of Neuropsychological Status at five time points (RBANS; baseline 12 months, 24 months, 36 months, and 48 months) were assessed using repeated measures analyses. Results: Total MoCA score significantly increased across time, particularly between the first and second administrations. Scores did not significantly differ between the second (12 month) and third (48 month) administrations. When grouped by baseline performance, individuals who scored low at baseline significantly improved performance at 12-month testing, but had little change between 12- and 48-month testing. Conversely, individuals who scored high at baseline did not significantly change between baseline and 12-month testing, but improved between 12- and 48-month testing. RBANS scores did not significantly change over time. Conclusions: These results suggest that the MoCA may be susceptible to practice effects, particularly between the first and second administrations. These practice effects should be taken into consideration when repeatedly employing the MoCA to screen for cognitive status in healthy older adults.

Longer self-reported sleep duration is associated with decreased performance on the montreal cognitive assessment in older adults.

Previous studies investigating the relationship between sleep duration and cognitive function in older adults have suggested that longer sleep durations are associated with decreased cognitive performance. The intent of this study is to determine if performance on the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Exam (MMSE) is associated with self-reported sleep duration in older adults. Data from 189 cognitively normal older adults aged 75 and older (mean age 89.29±7.62) and free of severe depression were used for this analysis. Individuals were grouped based on their self-reported hours of sleep (short duration=<7, normal duration=7, >9, and long duration=≥9). The Kruskal-Wallis test was used to discern group differences on the MoCA scores, while multinomial logistic regression was used to assess the association between MoCA and MMSE scores and sleep group. The long duration group had significantly lower MoCA scores than the normal duration group (p=0.02). The short duration group was not significantly different from the normal duration group (p=0.33). Individuals in the short duration group were more likely to have higher MoCA scores than those in long duration group after adjusting for age, gender, and presence of depressive symptoms [OR 0.86, 95% CI (0.76, 0.98), p=0.02]. The results of this study suggest that in a group of non-demented, very old subjects, self-reported sleep duration of nine or more hours is associated with decreased cognitive performance on the MoCA in older adults, even after accounting for age, gender, and presence of depressive symptoms.

Octogenarian and centenarian performance on the Fuld Object Memory Evaluation

The Fuld Object Memory Evaluation (FOME) has considerable utility for cognitive assessment in older adults, but there are few normative data, particularly for the oldest old. In this study, 80 octogenarians and 244 centenarians from the Georgia Centenarian Study completed the FOME. Total and trial-to-trial performance on the storage, retrieval, repeated retrieval, and ineffective reminder indices were assessed. Additional data stratified by age group, education, and cognitive impairment are provided in the Supplemental data. Octogenarians performed significantly better than centenarians on all FOME measures. Neither age group benefitted from additional learning trials beyond Trial 3 for storage and Trial 2 for retention and retrieval. Ineffective reminders showed no change across learning trials for octogenarians, while centenarians improved only between Trials 1 and 2. This minimal improvement past Trial 2 indicates that older adults might benefit from a truncated version of the test that does not include trials three through five, with the added benefit of reducing testing burden in this population.

Computerized cognitive testing for older adults: a review.

This article is a review of computerized tests and batteries used in the cognitive assessment of older adults. A literature search on Medline followed by cross-referencing yielded a total of 76 citations. Seventeen test batteries were identified and categorized according to their scope. Computerized adaptive testing (CAT) and the Cambridge Cognitive Examination CAT battery as well as 3 experimental batteries and an experimental test are discussed in separate sections. All batteries exhibit strengths associated with computerized testing such as standardization of administration, accurate measurement of many variables, automated record keeping, and savings of time and costs. Discriminant validity and test-retest reliability were well documented for most batteries while documentation of other psychometric properties varied. The large number of available batteries can be beneficial to the clinician or researcher; however, care should be taken in order to choose the correct battery for each application.