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Cognitive assessment in healthy and pathological aging

Thomann, Alessandra. Cognitive assessment in healthy and pathological aging. 2019, Doctoral Thesis, University of Basel, Faculty of Psychology.

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Official URL: http://edoc.unibas.ch/diss/DissB_13209

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Abstract

The current demographical development leads to a growing number of older people and thereby to an increase in patients suffering from age-related diseases like dementia. Facing this healthcare challenge requires an efficient and accurate diagnostic process. An understanding of healthy cognitive aging is essential to recognize and investigate pathological states. Further the diagnostic accuracy of a given tool needs to be assessed in the clinical setting where it is ultimately applied. The aim of the present doctoral thesis is to provide insights into the cognitive performance of cognitively healthy older individuals and to assess the diagnostic accuracy of a well-known tool in a realistic clinical routine setting.
We found demographic-related effects on cognitive performance in 283 cognitively healthy individuals who were assessed with two different cognitive assessment tools: the Montreal Cognitive Assessment (MoCA) and a newly developed computerized cognitive assessment (CogCheck). Adjusting for these effects by converting raw scores to standard scores, lead to higher specificity of the MoCA.
In a second study, we investigated the diagnostic accuracy of the original MoCA cut-off (25/26) in a clinical routine setting to differentiate cognitive normal findings from patients with a neurocognitive disorder (NCD; N = 496). While the original cut-off yielded high sensitivity, its specificity was poor. The classification rate increased when a lower cut-off score (23/24) was applied. However, sensitivity to detect mild NCD was low. We therefore proposed a new way to evaluate cognitive performance: Combining two separate cut-offs (23/24 and 26/27) with a gray area allows for both, high specificity and high sensitivity. Additional examinations are required in the gray area between these two cut-offs.
Finally, we have found important heterogeneities in the methodology of cognitive normative studies. This information may guide future endeavors to create guidelines for the definition of cognitive health, which is a baseline requirement to investigate pathological changes. As an outlook, methodological reflections on the evaluation of cognitive assessments are given and the role of neuropsychology in the age of digitalization is discussed.
Advisors:Monsch, Andreas U. and Grob, Alexander
Faculties and Departments:07 Faculty of Psychology
UniBasel Contributors:Monsch, Andreas U. and Grob, Alexander
Item Type:Thesis
Thesis Subtype:Doctoral Thesis
Thesis no:13209
Thesis status:Complete
Bibsysno:Link to catalogue
Number of Pages:1 Online-Ressource (115 Seiten)
Language:English
Identification Number:
Last Modified:08 Aug 2019 09:42
Deposited On:23 Jul 2019 14:05

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