Cognitive Assessment Methods Research Articles

A hybrid cognitive assessment based on ontology knowledge map and skills

An intelligent tutoring system plays vital role in education and its importance is constantly increasing, meanwhile the key challenge in the teaching learning process is assessing students’ learning efficiently. In this paper, a hybrid assessment based-on ACT-R cognitive learning theory, combining ontology knowledge map with skills is proposed. In order to assess how well students master knowledge structure, an ontology knowledge map is constructed to describe declarative knowledge; and in order to assess how well students master knowledge skills, a problem solving process is constructed to describe procedural knowledge based on ACT-R. Finally, a student’s mastery of knowledge is assessed through both the knowledge map and skills in the problem solving process, as well as auxiliary indicators like time usage, prior knowledge level, self-assessment, etc. This method is implemented in a geometric intelligent assessment system and is evaluated in a junior high school. Experiments show that the assessment results are consistent with students’ actual learning levels. The hybrid cognitive assessment method can not only obtain the score of students’ mastery of knowledge points and the structure through knowledge map, but also assess the learning skills in problem solving process through exercises quantitatively.

Cognitive Impairment in Schizophrenia: Characteristics, Assessment, and Treatmentedited by HarveyPhilip D.. New York, Cambridge University Press, 2013, 328 pp., $95.00.

Cognitive Impairment in Schizophrenia: Characteristics, Assessment, and Treatmentedited by HarveyPhilip D.. New York, Cambridge University Press, 2013, 328 pp., $95.00.

Experimentally induced distraction impacts cognitive but not emotional processes in think-aloud cognitive assessment.

Studies have examined the impact of distraction on basic task performance (e.g., working memory, motor responses), yet research is lacking regarding its impact in the domain of think-aloud cognitive assessment, where the threat to assessment validity is high. The Articulated Thoughts in Simulated Situations think-aloud cognitive assessment paradigm was employed to address this issue. Participants listened to scenarios under three conditions (i.e., while answering trivia questions, playing a visual puzzle game, or with no experimental distractor). Their articulated thoughts were then content-analyzed both by the Linguistic Inquiry and Word Count (LIWC) program and by content analysis of emotion and cognitive processes conducted by trained coders. Distraction did not impact indices of emotion but did affect cognitive processes. Specifically, with the LIWC system, the trivia questions distraction condition resulted in significantly higher proportions of insight and causal words, and higher frequencies of non-fluencies (e.g., “uh” or “umm”) and filler words (e.g., “like” or “you know”). Coder-rated content analysis found more disengagement and more misunderstanding particularly in the trivia questions distraction condition. A better understanding of how distraction disrupts the amount and type of cognitive engagement holds important implications for future studies employing cognitive assessment methods.

Cognitive function in adults aging with fabry disease: a case-control feasibility study using telephone-based assessments.

We examined the feasibility of recruiting US adults ≥45 years old with Fabry disease (FD) for telephone assessments of cognitive functioning. A case-control design matched each FD participant on age, sex, race, and education to four participants from a population-based study. Fifty-four participants with FD age 46-72 years were matched to 216 controls. Standardized cognitive assessments, quality of life (QOL), and medical histories were obtained by phone, supplemented by objective indices of comorbidities. Normalized scores on six cognitive tasks were calculated. On the individual tasks, scores on list recall and semantic fluency were significantly lower among FD participants (p-values < 0.05), while scores on the other four tasks did not differ. After averaging each participant's normalized scores to form a cognitive composite, we examined group differences in composite scores, before and after adjusting for multiple covariates using generalized estimating equations. The composite scores of FD cases were marginally lower than controls before covariate adjustments (p = 0.08). QOL and mental health variables substantially attenuated this finding (p = 0.75), highlighting the influence of these factors on cognition in FD. Additional adjustment for cardiovascular comorbidities, kidney function, and stroke had negligible impact, despite higher prevalence in the FD sample. Telephone-based cognitive assessment methods are feasible among adults with FD, affording access to a geographically dispersed sample. Although decrements in discrete cognitive domains were observed, the overall cognitive function of older adults with FD was equivalent to that of well-matched controls before and after accounting for multiple confounding variables.

Routine clinical assessment of cognitive functioning in schizophrenia, major depressive disorder, and bipolar disorder

As more evidence points to the association of cognitive dysfunction with mental health disorders, the assessment of cognitive function in routine clinical care of these disorders is increasingly important. Despite this, it remains unknown how cognitive function is measured in routine clinical practice. The objective of this study was to assess psychiatrists' awareness of cognitive dysfunction in mental health disorders and their methods of cognitive assessment. An online survey was disseminated to psychiatrists in Europe, Asia, Australia and the United States. The survey asked about their perceptions of cognitive dysfunction in several mental health disorders, knowledge of cognitive assessment, method of cognitive assessment, and instruments used to measure cognitive function. Among the 61 respondents, most perceived that schizophrenia was associated with the greatest cognitive dysfunction. Many were unaware whether guidelines were available on cognitive assessment. In schizophrenia, 59% of psychiatrists reportedly used cognitive instruments, while the remainder relied solely on patient history interviews. The use of instruments to assess cognition in major depressive disorder (MDD) and bipolar disorder (BPD) was lower, 38% and 37% respectively. Of the reported instruments used, only a few were actually appropriate for use in the diseases of interest (12% in schizophrenia, 3% in MDD and 0% in BPD). Other instruments reported were clinical measures that did not assess cognition. These findings reveal some inconsistencies in psychiatrists' routine clinical evaluation of cognitive function. There appeared to be low use of true cognitive assessment instruments in clinical practice and confusion regarding what constituted a cognitive assessment instrument.

Test Accuracy of Short Screening Tests for Diagnosis of Delirium or Cognitive Impairment in an Acute Stroke Unit Setting

Guidelines recommend cognitive screening in acute stroke. Various instruments are available, with no consensus on a preferred tool. We aimed to describe test accuracy of brief screening tools for diagnosis of cognitive impairment and delirium in acute stroke. We collected data on sequential stroke unit admission in a single center. Four assessors trained in cognitive testing independently performed screening and reference tests. Brief assessments comprised the following: 10- and 4-point Abbreviated Mental Test (AMT-10; AMT-4); 4-A Test (4AT); Clock Drawing Test (CDT); Cog-4; and Glasgow Coma Scale (GCS). We also recorded the multidisciplinary team's informal review using single question (SQ). We compared against reference standards of Montreal Cognitive Assessment (MoCA) and Confusion Assessment Method for delirium using usual diagnostic cutpoints. For MoCA, we described effects of lowering the diagnostic threshold to MoCA <24 and MoCA <20. We described sensitivity, specificity, and positive and negative predictive values. Over a 10-week period, 111 subjects had cognitive assessment data. Subjects were 50% male (n=55), and median age was 74 years (interquartile range, 64-85). AMT-4, AMT-10, and SQ all had excellent (1.00) specificity for detection of cognitive impairment, although sensitivity was poor (all <0.60). The 4AT had greatest sensitivity for detecting delirium (1.00 [confidence interval [CI], 0.74-1.00]) and reasonable specificity (0.82 [CI, 0.72-0.89]). Properties of 4AT for detection of cognitive impairment, at the traditional MoCA threshold, were also good (sensitivity, 0.86; specificity, 0.78). Using diagnostic thresholds of MoCA ≤26, <24, and <20 gave proportions with cognitive impairments of 86%, 61%, and 49%, respectively, with resulting changes in screening test properties. At lower MoCA thresholds, CDT had favorable sensitivity and specificity (MoCA <20: sensitivity, 0.93, specificity, 0.66; MoCA <24: sensitivity, 0.85, specificity, 0.77). Many brief screening assessments are specific but not sensitive for detection of cognitive impairment in acute stroke. Our primary analysis suggests that 4AT is a reasonable choice for delirium and cognitive screening in this setting. However, these data are based on standard MoCA diagnostic threshold and may not be suited for an acute stroke population.

“People like numbers”: a descriptive study of cognitive assessment methods in clinical practice for Aboriginal Australians in the Northern Territory

BackgroundAchieving culturally fair assessments of cognitive functioning for Aboriginal people is difficult due to a scarcity of appropriately validated tools for use with this group. As a result, some Aboriginal people with cognitive impairments may lack fair and equitable access to services. The objective of this study was to examine current clinical practice in the Northern Territory regarding cognitive assessment for Aboriginal people thereby providing some guidance for clinicians new to this practice setting.MethodQualitative enquiry was used to describe practice context, reasons for assessment, and current practices in assessing cognition for Aboriginal Australians. Semi-structured interviews were conducted with 22 clinicians working with Aboriginal clients in central and northern Australia. Results pertaining to assessment methods are reported.ResultsA range of standardised tests were utilised with little consistency across clinical practice. Nevertheless, it was recognised that such tests bear severe limitations, requiring some modification and significant caution in their interpretation. Clinicians relied heavily on informal assessment or observations, contextual information and clinical judgement.ConclusionsCognitive tests developed specifically for Aboriginal people are urgently needed. In the absence of appropriate, validated tests, clinicians have relied on and modified a range of standardised and informal assessments, whilst recognising the severe limitations of these. Past clinical training has not prepared clinicians adequately for assessing Aboriginal clients, and experience and clinical judgment were considered crucial for fair interpretation of test scores. Interpretation guidelines may assist inexperienced clinicians to consider whether they are achieving fair assessments of cognition for Aboriginal clients.

Assessing the performance of the four question abbreviated mental test in the acute geriatric setting

Background: Cognitive impairment is common amongst acute geriatric hospital admissions but detection is often poor and this is associated with worse outcomes. The four-question abbreviated mental test (AMT4) has previously been promoted nationally in the acute setting as a succinct assessment tool. However, a recent national dementia Commissioning for Quality and Innovation (CQUIN) goal recommends a single screening question followed by the tenquestion abbreviated mental test (AMT10). We aimed to evaluate the negative predictive value of the AMT4 within the acute setting by comparing it to three other validated tools. Methods: We identified 100 acute medical admissions (&gt;60 years old) with a negative AMT4 and administered the AMT10, six-item cognitive impairment test (6CIT) and confusion assessment method (CAM) within 24 hours of admission. Results: Forty-six percent of the participants scored positively on at least one of the additional tests despite a negative AMT4. Forty-four patients had a positive 6CIT, 23 had a positive AMT10 and six had a positive CAM. Using the 6CIT as a diagnostic standard, tests of short-term memory had the greatest sensitivity and specificity for cognitive impairment. Conclusions: Nearly half of the participants had signs of cognitive impairment despite a negative AMT4. Consequently, there is a risk of under diagnosis with potentially serious consequences for morbidity and mortality. Tests of shortterm memory were strongly associated with cognitive impairment. We propose the addition of such a test in order to increase the sensitivity of the AMT4 without compromising its brevity and utility in the acute setting.

P4‐348: Self‐reported memory fails to substitute for objective memory measures

Background: Cognitive assessment of geriatric patients is now widely recognized as necessary to improve safety and medication compliance. Physicians prefer cognitive assessment methods that are fast and inexpensive. Doctors sometimes just ask patients to assess their own cognition. How accurate are self-reports of cognitive abilities when compared to objective measures obtained by computerized testing? Methods: We examined the relationships between objective memory and executive function measures and three subjective patient questions concerning mental clarity, concentration and memory. 7778 subjects were tested in US medical facilities (6/22/2011-2/15/2012) with the CANSMCI, a computer-administered cognitive examination designed for the earliest detection of MCI. The sample included normal, mildly impaired and demented patients: Age=67.9 (SD=15), 59% female. The median test time was 34 minutes, including answers to depression, cognitive ability, pain and head injury questions. In a subset, CANS-MCI measures were also validated against more traditional measures administered within an independent full neuropsychological evaluation. Results: Patients self-reporting problems with mental clarity and concentration actually performed better on immediate, delayed and guided recall (all p 25). Regression found the most powerful predictor of self-reported cognitive symptoms was age, with younger people unexpectedly reporting more symptoms than 65+ patients. Analyses restricted to age > 65 found that those patients who report problems with their mental clarity and concentration perform better on objective memory tests than do patients who do not report those problems. In all age groups, subjective memory symptoms were not significantly correlated with objective memory measures. In the > 65 cohort, the strongest predictors of self-reported cognitive symptoms were depression, pain, and head injury history. In the validation subset (N=169), the CANS-MCI factor scores were as accurate at detecting impairment as full neuropsychological examinations when DRS2, WMS1 and WMS2 are considered the criterion standards. Conclusions: Self-reported cognitive problems do not match objective memory measures and may deceive medical professionals, since age, depression and pain all affect cognitive complaints. While the utility of caregiver/family assessment is well-established, asking patients to self-identify memory problems is not. The failure to obtain positive results in this very large data set suggests that clinicians using subjective patient memory concerns as substitutes for objective testing are often misguided. The CANS-MCI is a valid screening measure to determine longitudinal changes and the need for further assessment. *Research Director, Screen, Inc. **Director of Clinical Services, Screen, Inc. ***Founder and CEO, Screen, Inc.

Implicit Attitudes Toward Violence Among Male Perpetrators of Intimate Partner Violence

Whereas cognitive variables are hypothesized to play an important role in intimate partner violence (IPV) etiology and intervention, cognitive assessment methods have largely targeted offenders' explicit, controlled cognitive processing using paper-and-pencil questionnaires prone to social desirability biases. Using an implicit measure of attitudes (the Implicit Association Test [IAT]), we assessed attitudes toward gender, violence, and the association between gender and violence among 50 men enrolled in an IPV treatment program and a comparison sample of 40 nonviolent (NV) men. Although no group differences were noted on explicit attitudinal measures, men in the IPV group showed more positive implicit attitudes regarding violence, and a more rapid association between women and violence. Among men in treatment for IPV, the attitudes toward violence IAT was significantly correlated with self/partner-reported IPV frequency. In accordance with social information processing models of aggression, these results suggest that aggressogenic attitudes are likely to operate automatically and with little conscious deliberation. As a result, clinicians and researchers must adapt assessment and intervention strategies to capture both implicit and explicit aspects of cognitive processing.

Bedside cognitive assessments and falls risk in Parkinson’s disease

Cognitive deficits may contribute to falls in Parkinson's disease (PD) and these deficits may be risk factors for falls. However, their association with falls has been generally studied in patients with continuous gait problems. There have been few studies in PD patients without postural instability. In addition, the effectiveness of various simple bedside cognitive tests in predicting falls has not been established. In this study, we investigated the effectiveness of three bedside cognitive tests in consecutive patients with PD without postural instability. Of the 119 patients, 39 experienced falls during the follow-up period. Of the bedside cognitive assessment methods examined, only the Montreal Cognitive Assessment (MoCA) score was significantly lower in the group of fallers than in the group of non-fallers. This result suggests that the MoCA is effective as a bedside test for evaluating the risk of falls.

Validity and Reliability of Cognitive Assessment Using Virtual Environment Technology in Patients with Stroke

We assessed the validity and reliability of a virtual environment technology (VET)-based cognitive assessment program that was developed as a measurement tool of cognitive abilities in patients after a stroke. Twenty participants diagnosed with stroke caused by unilateral brain lesions were enrolled to assess the VET program's validity and test-retest reliability. Participants underwent evaluation by paper-based neuropsychological tests including the Korean Mini-Mental Status Examination, the Korean-Wechsler Adult Intelligence Scale, the Motor Free Visual Perception Test, Rey-Kim Memory Test, and Kim's Frontal-Executive Neuropsychologic Test as well as the VET-based cognitive assessment. Major variables and indices of the VET program were calculated. The VET program validity was evaluated using a simple correlation analysis between variables from the VET program and conventional paper-based neuropsychological measurements, and the reliability was evaluated by investigating the test-retest correlation coefficients. Major variables and indices of the VET program in patients with stroke correlated significantly with the related scores of paper-based neuropsychological tests. In addition, the test-retest reliability analysis revealed that the correlation coefficients ranged from 0.528 to 0.926. The VET-based cognitive assessment program showed adequate reliability and validity as a method of cognitive assessment in patients after stroke.

Cerebral emboli and cognitive function after intramedullary fracture fixation

Introduction Cerebral emboli have been detected during intramedullary orthopaedic procedures. The quantity of emboli produced and their clinical effects are currently not known. This study aimed to quantify the intra-operative cerebral embolic load using transcranial Doppler ultrasound during the intramedullary stabilisation of femoral and tibial diaphyseal fractures. Clinical cognitive function was also assessed after surgery and any relationship to the cerebral embolic load determined. Patients and methods Prospective cohort study of 20 patients with femoral or tibial diaphyseal fractures treated with reamed intramedullary nailing. The intra-operative cerebral embolic load was measured using transcranial Doppler ultrasound of the middle meningeal artery. Cognitive function was assessed 3 days after surgery using a range of validated neuropsychological tests. The cognitive results were compared to predicted scores matched for age and intelligence quotient as is the standard method of cognitive assessment after trauma. Results Four patients had detectable cerebral emboli with counts of only 2, 3, 3, and 9 respectively. A significantly poorer than predicted cognitive score occurred in immediate and delayed memory recall tests. However there was no significant difference in any cognitive function score between those patients who had detectable cerebral emboli and those who did not. Discussion Small numbers of cerebral emboli were detected during intramedullary stabilisation of lower limb long bone fractures but with no apparent cognitive effect. This poor correlation is similar to recent studies performed on arthroplasty patients and also conforms to the extensive cardiac surgery literature which would indicate that such low levels of systemic embolisation are unlikely to consistently produce cerebral clinical effects.

Prenatal Exposure to Polychlorinated Biphenyls: A Neuropsychologic Analysis

ObjectivesA large body of literature documents the effects of prenatal exposure to polychlorinated biphenyls (PCBs) on cognitive development of children. Despite this fact, no integrative synthesis has been published yet to identify the cognitive functions that are particularly affected. Our aim is to review this literature in an attempt to identify the cognitive profile associated with prenatal PCB exposure.Data sourcesStudies were identified by searching the PubMed database for articles published before June 2008. We reviewed data from nine prospective longitudinal birth cohorts for different aspects of cognition.Data extractionAssociations between indicators of prenatal PCB exposure and performance on cognitive tasks reported in the selected studies are summarized and classified as general cognitive abilities, verbal or visual–spatial skills, memory, attention, and executive functions.Data synthesisThe most consistent effects observed across studies are impaired executive functioning related to increased prenatal PCB exposure. Negative effects on processing speed, verbal abilities, and visual recognition memory are also reported by most studies. Converging results from different cohort studies in which exposure arises from different sources make it unlikely that co-exposure with another associated contaminant is responsible for the observed effects.ConclusionPrenatal PCB exposure appears to be related to a relatively specific cognitive profile of impairments. Failure to assess functions that are specifically impaired may explain the absence of effects found in some studies. Our findings have implications in the selection of cognitive assessment methods in future studies.

How Should DSM-V Criteria for Schizophrenia Include Cognitive Impairment?

Neurocognitive impairment is considered a core component of schizophrenia and is increasingly under investigation as a potential treatment target. On average, cognitive impairment is severe to moderately severe compared with healthy controls, and almost all patients with schizophrenia demonstrate cognitive decrements compared with their expected level if they had not developed the illness. Compared with patients with affective disorders, cognitive impairment in schizophrenia appears earlier, is more severe, and tends to be more independent of clinical symptoms. While the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, description of schizophrenia includes several references to cognitive impairment, neither the diagnostic criteria nor the subtypology of schizophrenia include a requirement of cognitive impairment. We forward for consideration a proposal that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria include a specific criterion of "a level of cognitive functioning suggesting a consistent severe impairment and/or a significant decline from premorbid levels considering the patient's educational, familial, and socioeconomic background." The inclusion of this criterion may increase the "point of rarity" with affective psychoses and may increase clinicians' awareness of cognitive impairment, potentially leading to more accurate prognosis and better treatment outcomes. Future research will need to address the validity of these possibilities. The reliable determination of cognitive impairment as part of a standard diagnostic evaluation may present challenges to diagnosticians with limited resources or insufficient expertise. Various cognitive assessment methods for clinicians, including brief assessments and interview-based assessments, are discussed. Given the current emphasis on the development of cognitive treatments, the evaluation of cognition in schizophrenia is an essential component of mental health education.

Implementation of IDEA: Integrating response to intervention and cognitive assessment methods

AbstractThe Individuals with Disabilities Education Improvement Act (IDEA) was reauthorized by the U.S. Congress in 2004, yet ongoing regulatory efforts are required to determine its operationalization and implementation. Of particular concern to school psychologists and others involved in the educational process are the guidelines for identification of children with specific learning disabilities (SLD). Two seemingly opposite camps have been arguing for either a response‐to‐intervention (RTI) approach for SLD identification or a methodology that includes comprehensive evaluations for SLD identification and intervention purposes. In this article, the authors propose a resolution to these critical issues by emphasizing a multitiered approach to serving children with learning problems—one that begins with RTI, but then provides for comprehensive evaluation of cognitive processes if RTI methods are not successful in ameliorating the child's learning difficulties. If a child fails to respond to intervention and demonstrates a deficit in the basic psychological processes following comprehensive evaluation, both the definitional criteria for SLD and the method for determining SLD eligibility will be addressed. This methodology incorporates the best aspects of both the RTI and comprehensive evaluation perspectives to forge a balanced practice model that ensures diagnostic accuracy and optimizes educational outcomes for children with SLD. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 753–770, 2006.

Cognitive status of young and older cigarette smokers: Data from the international brain database

Previous studies that have examined the impact of cigarette smoking on cognition have revealed mixed results; some studies report no impact and others report detrimental effects, especially in older individuals. Few studies, however, have examined the effects of cigarette smoking on both young and old healthy individuals using highly robust and standardized methods of cognitive assessment. This study draws on an international database to contrast cognitive differences between younger and older individuals who regularly smoke cigarettes and non-smokers. Data were sampled from 1000 highly screened healthy individuals free of medical or psychiatric health complications. A cohort of 62 regular smokers ( n = 45 < 45 years of age; n = 17 ⩾ 45 years) with a Fagerstrom nicotine dependency score of 1 or more were identified and matched to a cohort of 62 healthy nonsmokers ( n = 43 < 45 years; n = 19 ⩾ 45 years) on demographic variables and estimated intelligence. Performances on cognitive measures of attention, reaction time, cognitive flexibility, psychomotor speed, and memory were considered for analysis. As a group, smokers performed more poorly than nonsmokers on one measure of executive function. A significant age and smoking status interaction was identified with older smokers performing more poorly than older nonsmokers and younger smokers on a measure of long-delayed recall of new information. Cigarette smoking is associated with isolated and subtle cognitive difficulties among very healthy individuals.

General methodological considerations for the assessment of nutritional influences on human cognitive functions

The premise that cognitive functioning can be influenced through dietary means has gained widespread interest. The assessment of cognitive functioning is a key method to scientifically substantiate such nutritional effects on cognition. The current paper provides a basic overview of the main concepts, issues and pitfalls of human cognitive research. General methods of cognitive assessment, selection of appropriate tests, factors that may mediate task performance and issues pertaining to the interpretation of the results are discussed.

Easing Internet access of health information for elderly users

Elderly users are increasingly becoming active consumers of Internet technologies. Developing websites dedicated to this user group presents several design issues (such as that of ‘design for all’, participatory design, patient empowerment and cognitive usability assessment methods). SeniorGezond is a health information resource currently under development. It aims to support elderly users in their search and access of appropriate information in the area of fall incidences. The current development of SeniorGezond provides a useful illustration on how design issues can be addressed and applied in a practical setting.

The Relationship between Physical Activity and Cognition in Children: A Meta-Analysis

The purpose of this study was to quantitatively combine and examine the results of studies pertaining to physical activity and cognition in children. Studies meeting the inclusion criteria were coded based on design and descriptive characteristics, subject characteristics, activity characteristics, and cognitive assessment method. Effect sizes (ESs) were calculated for each study and an overall ES and average ESs relative to moderator variables were then calculated. ESs (n = 125) from 44 studies were included in the analysis. The overall ES was 0.32 (SD = 0.27), which was significantly different from zero. Significant moderator variables included publication status, subject age, and type of cognitive assessment. As a result of this statistical review of the literature, it is concluded that there is a significant positive relationship between physical activity and cognitive functioning in children.