New Technologies and Neuropsychological Evaluation of Older Adults: Issues and Challenges

New Technologies and Neuropsychological Evaluation of Older Adults: Issues and Challenges

Stelios Zygouris (3rd Department of Neurology, Aristotle University of Thessaloniki, Greece) and Magda Tsolaki (Greek Association of Alzheimer's Disease and Related Disorders 3rd Department of Neurology, Aristotle University of Thessaloniki, Greece)
DOI: 10.4018/978-1-4666-8234-4.ch001
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Abstract

In this chapter the history of computerized cognitive testing for older adults is reviewed critically, challenges are being highlighted and solutions and emerging trends are discussed. Issues such as lack of validation, insufficiently documented psychometric properties and the high cost of computerized instruments are analyzed. At the same time a discussion concerning the lack of integration of computerized testing in healthcare highlights management issues and the need for a paradigm shift. Possible solutions to the issues presented and new avenues of research are identified. Emerging technologies such as adaptive testing, virtual reality (VR) environments, and reliable speech recognition software are presented and their potential is highlighted. At the same time social and scientific trends such as the shift to early detection and the increasing familiarity of older adults with technology are analyzed. The chapter concludes with an outline of the expected future of computerized testing.
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Background

As the world’s population ages, issues concerning the cognitive health of older adults become ever more pressing. Dementia is becoming a major public health concern that exerts a heavy social and economic toll upon most societies. Worldwide there are 35.6 million people living with dementia and this number is expected to double by 2030 and triple by 2050. Prevalence of dementia ranges from 1% in persons under 65 years old up to 45% in persons over 85 years old. The global prevalence of dementia in people aged 60 and over is around 6%. Alzheimer’s disease is the most common form of dementia accounting for 60 – 70% of dementia cases worldwide. Dementia is among the ten leading causes of death in high-income countries and one of the major causes of disability and dependency among older people worldwide. Globally it costs more than $604 billion each year in medical and social care expenses and loss of income of patients and caregivers, a figure that represents 1% of the worldwide gross domestic product (World Health Organization, 2012).

The global effort against dementia and cognitive disorders in general focuses on early diagnosis. On average a new case of dementia is detected every four seconds however dementia remains largely underdiagnosed even in high-income countries as less than half of dementia cases are routinely recognized. Usually diagnosis comes at an advanced stage of the disease thus limiting treatment options. Diagnosis in primary care is difficult as general practitioners and family doctors often lack the necessary specialized knowledge (Waldemar, et al., 2007) while referrals for specialized neuropsychological testing are costly and time consuming.

Computerized cognitive testing has been proposed as a means to aid diagnosis and facilitate record keeping thus enabling health services to deal with the ever increasing number of older adults that have to be screened for dementia. It offers distinct advantages compared to traditional pencil and paper tests such as savings of costs and time, accurate recording of responses and the ability to automatically store and compare a person’s performance between testing sessions. Test administration is standardized and unaffected by examiner bias while computerized tests can often be administered by personnel with limited training such as nurses and health care associates. Furthermore many computerized instruments offer alternate batteries for brief screening or for assessing specific cognitive functions. A number of these tests allow the clinician to create custom batteries in order to deal with specific situations and clinical needs. Finally some tests can adapt to the examinee’s level of performance enabling them to cover a wide range of cognitive ability while minimizing floor and ceiling effects (Zygouris & Tsolaki, 2014).

The relationship between neuropsychology and technology dates back to the introduction of the first personal computers. Neuropsychologists and test designers have always monitored technological progress and were quick to implement new technologies in neuropsychological testing and evaluation (Zygouris & Tsolaki, 2014). One could argue that test designers adopted new technology with a high degree of enthusiasm and saw technology as a means to improve testing and evaluation.

Key Terms in this Chapter

Alzheimer’s Disease (AD): Alzheimer’s disease is a neurodegenerative disease that appears in older adults. It is characterized by cognitive dysfunction and memory loss as well as by functional decline. Currently there is no cure for AD and since its prevalence is on the rise due to an aging of the global population research on this field is intensive.

Instrumental Activities of Daily Living (IADL): Instrumental activities of daily living are those daily activities that are necessary for autonomous living and present a level of complexity that is above that of basic activities of daily living (BADL). Examples of IADL are managing doctor’s appointments, managing finances, preparing meals etc. Examples of BADL are the ability to dress, shower, eat etc.

Computerized Adaptive Testing: Computerized adaptive testing is a technology which tailors the difficulty level of a computerized test to the examinee’s ability level with the aim of reducing administration time and minimizing floor and ceiling effects.

Neuropsychological Testing: Neuropsychological testing refers to the process of assessing a person’s cognitive functioning through the use of standardized psychological tests. Such tests may examine general cognitive functioning or specific cognitive domains such as memory, attention, executive function etc.

Computerized Cognitive Testing: Computerized cognitive testing is a broad term that covers any cognitive measure that is administered through a digital device such as a personal computer, laptop, tablet PC etc.

Virtual Reality (VR): Virtual reality is the technology that enables a person to perceive a digital environment with a high degree of realism and interact with it. Depending on the technological instruments used VR can have varying degrees of realism.

Mild Cognitive Impairment (MCI): Mild cognitive impairment is a condition that represents a middle ground between normal aging and Alzheimer’s disease. Persons with MCI may report subjective memory complaints and exhibit low performance in neuropsychological tests but they are otherwise able to live autonomously though they may encounter difficulties in performing complex IADL such as managing their finances.

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