QUEBEC CITY – Computerized assessment of mild cognitive impairment is an area of great promise and potential problems, Jason Brandt, Ph.D., said at a conference sponsored by the American Association for Geriatric Psychiatry.
A slew of new computerized tests are on the market; they're very professionally produced, glitzy, and fun to do, Dr. Brandt said. They're cost effective and provide rapid results. They can also be administered repeatedly, which makes them useful in monitoring cognitive progression and treatment effect.
But the tests need to meet established standards of reliability, validity, and lack of bias, said Dr. Brandt, professor and director of the division of medical psychology, Johns Hopkins Hospital, Baltimore. Tests also need to be adaptive to the needs of patients such as those with sensory or motor deficits.
In addition, it has to be established, and not assumed, that tests administered, scored, and interpreted by computer are comparable with traditional “pencil and paper” tests.
“Just because we call them by the same name or assert them to be measuring the same construct, doesn't mean that's true,” he said. So far, none of the computerized tests have met these conditions to his satisfaction, he said in an interview.
Some of the tests currently available are:
▸ Computer Administered Neuropsychological Screen for Mild Cognitive Impairment or CANS-MCI (Screen, Inc., Seattle) takes about 30 minutes on a personal computer with a mouse or touch screen and measures visual spatial skills, mental control, language fluency, and both immediate and delayed memory.
A recent National Institute on Aging-funded study in 310 elderly patients concluded that the test shows promise as a reliable and valid screening tool in determining if more intensive testing is warranted (J. Neuropsychiatry Clin. Neurosci. 2005;17:98–105).
▸ Mindstreams (NeuroTrax Corp., New Brunswick, N.J.) is a cognitive battery that significantly discriminated between 30 patients with mild cognitive impairment and 39 healthy elders (J. Mol. Neurosci. 2004;24:33–44). Measures of memory, executive function, visual spatial skills, and verbal fluency discriminated best. Discrimination was at least comparable with that of traditional neuropsychological tests in these domains.
▸ CNS Vital Signs (CNS Vital Signs, Chapel Hill, N.C.), which is just beginning to be explored by clinicians at Johns Hopkins, includes seven tests that can be administered in about 40 minutes or more. CNS Vital Signs provides an elaborate printout with a variety of scores, but the question is whether patients will use it, he said.
If mild cognitive impairment is suspected, Dr. Brandt recommended that primary care physicians refer their patients to a board-certified clinical neuropsychologist who specializes in disorders of the elderly.
The choice of assessment techniques for any given patient should be left up to the neuropsychologist.