lecture 9 - assessment in old age and dementia Flashcards
key domains in neuropsychological assessment of older adults
-medical history and medications
-informant reports
-clinical interview: mood and mental status test
-cognitive assessment
-activities of daily living/ functional capacity
-legal decision-making capacity
what is the activities of daily living vs the instrumental activities od daily livinf
-ADL
-basic activities of dl
-feeding.continence, bathing, personal, grooming, movement
-IADL
-functional abilities
* Shopping, cooking, managing finances, reading,
news awareness, transport.
* Assessed using self-report or performance- based tasks
* Measure functional independence
assessment of ADL
-observed performance on everyday tasks
-Self-report/informant-report: e.g.
Barthel index of basic ADL
Observe performance on
everyday tasks
E.g. make cup of tea, get dressed
More ecologically valid and not
reliant on self-report
Time and resource intensive, not
standardised
Self-report/informant-report: e.g.
Barthel index of basic ADL
-Questionnaire/interview format
-Covers feeding, bathing, dressing etc.
-Inter-rater reliability > .9, test-retest >.8,
-Good construct & predictive validity
-Lack of awareness, and reporting biases
assessing instrumental activities of daily living (IADLs)
-most commonly used for
-reliability and validity
Lawton IADL assessment most commonly used
* Self- or informant- report
* 8 domains: telephone, shopping, food prep, housekeeping, laundry,
transport, medication, finances
- Reliability and validity of IADL assessment
-Good reliability: Inter-rater > .8; Cronbach’s alpha > .9
-Good construct validity: Factor analysis confirmed 1 factor - Criterion validity: IADL predicts healthy, mild cognitive impairment (MCI), dementia
-Convergent validity with other measure of functional status BUT few studies
diagnosis of dementia (probable Alzheimer’s disease) DSM V
-criteria
- Evidence of significant cognitive decline:
* Concern of the individual, informant or clinician; and
* Substantial impairment in standardized neuropsychological testing in memory plus at least one other cognitive domain. - Cognitive deficits interfere with everyday activities.
- Cognitive deficits not attributable to delirium or other mental disorder (e.g., major depressive disorder, schizophrenia) or other aetiology (e.g. stroke).
- Insidious onset and gradual progression of impairment.
neuropsychological assessment in procedures in suspected dementia
-medical background and personal history
-mental state assessment
-current cognitive functioning
:*memory and language
*attention and executive function
-premorbid ability
-mood
-ADLs
-importance of assessing change over time
how is assessment of mental state done
- Quick assessment of orientation, memory, thought, feeling, judgement.
- Indication of basic global cognitive function
- Key test: Mini Mental State Exam (MMSE) - Scored out of 30: healthy adults score 27-30
mini mental state examination
- Orientation: What is the year/season/date/day/month?
- Registration & recall: Repeat 3 words, later given surprise recall test
- Attention: Serial 7s
- Language: Name objects and repeat sentence.
- Motor abilities: copy drawing
MMSE evaluation
-reliability
-dementia sensitivity
-specificity
-executive function
- Good reliability: e.g. test-retest = .8
- Good sensitivity to dementia (predictive validity):
- Using cut off score <24, 80-90% accurate distinguishing dementia from healthy controls
- Poor specificity: Numerous reasons for low scores
- E.g. very old age, stroke, delirium, depression…..
- Not very sensitive to:
- Early/mild dementia
- Dementia in highly educated people
- Does not assess executive function, problem-solving
- Basic screening test
- Needs to be interpreted in relation to other tests and demographic factors
how can we asses cognitive function in dementia
Rey Auditory Verbal Learning Test (RAVLT)
Verbal episodic memory performance in AD
