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

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.