Cognitive testing: Purpose, scope, innovation. Claudia Jacova Assistant Professor Division of Neurology
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1 Cognitive testing: Purpose, scope, innovation Claudia Jacova Assistant Professor Division of Neurology
2 Cognition All mental processes involved in acquiring, storing and utilizing information Pretty much any mental work
3 From pathology to cognition Healthy Early Alzheimer Disease Scans from the Alzheimer Research Unit archives Courtesy of Dr. Ian R.A. Mackenzie
![SCREENING [BRIEF] TESTS: Designed to identify cognitive impairment.](/docs-images/81/83172523/images/4-2.jpg "Test score reflects global ability or mental status.")
4 SCREENING [BRIEF] TESTS: Designed to identify cognitive impairment. Test score reflects global ability or mental status. Specific cognitive domains not measured. NEURO- PSYCHOLOGICAL TESTING: Designed to identify patterns of cognitive impairment. Multiple test scores reflect abilities in the domains of learning / memory, language, attention, perception & construction, reasoning and problem-solving Jacova et al. Alzheimer s & Dementia 2007
5 Purposes of testing NO: Normal Aging IS THERE A PROBLEM? Screening tests YES: Mild Cognitive Impairment (MCI) Dementia WHAT IS THE CAUSE OF PROBLEM: NEURODEGENERATIVE DISORDER? WHAT TYPE? NP tests HOW DOES THE PROBLEM CHANGE OVER TIME?
6 Screening tests At UBCH-CARD: Mini Mental State Exam (MMSE) / Modified Mini Mental State Exam (3MS) Montreal Cognitive Assessment (MoCA) STRENGTHS Both can detect dementia MoCA can detect MCI LIMITATIONS Even MoCA may miss a problem when it is very mild Neither can inform on the cause of the problem Neither can predict how the problem is going to evolve Jacova et al. Alzheimer s & Dementia 2007
7 Beware of ceiling effects Jacova et al. Dement Geriatr Cogn Disord 2008
8 Purposes of testing NO: Normal Aging IS THERE A PROBLEM? Screening tests YES: Mild Cognitive Impairment (MCI) WHAT IS THE CAUSE OF PROBLEM: NEURODEGENERATIVE DISORDER? WHAT TYPE? NP tests HOW DOES THE PROBLEM CHANGE OVER TIME?
9 Neuropsychological testing Probes the functioning of a wide range of cognitive domains associated with putative brain regions Purposes: determine patterns of impairment that can help pinpoint the cause and predict the course of the problem help in the diagnosis of mood disorders identify preserved functions for the management of cognitive disorders Ideal but not widely accessible! Jacova et al. Alzheimer s & Dementia 2007
10 % Mix of Diagnosis UBCH CARD diagnoses Waiting times for 50 new patients > 6 months, for Epoch Total Number of New Patients evaluated per year % AD % other dementias %NCI & CIND N per year >2-fold increase in new patients/year Patients are younger, symptoms milder Non-AD dementia diagnosis more frequent neuropsychological testing > 24 months Courtesy of Dr. G.-Y. Robin Hsiung
11 Changing diagnostic criteria Towards Early (pre-dementia) diagnosis Use of biomarkers to support diagnosis Ever increasing effort to recognize underlying pathology/ies Dubois, Feldman, Jacova et al. Lancet Neurology 2007; 2010
12 What if we administered a cognitive test online? What if this test could tell us what type of clinico-biological assessment will be needed?
13 The future Cognitive testing on the computer (C-TOC) could be taken by people from their own homes upon referral to a clinic Test results could inform on the assessments and biomarker studies people may need Biomarker studies could be set up well ahead of the clinic visit C-TOC has the potential to significantly contribute to improving assessment, management, and care in dementia clinics Thank you!
14 The UBC Team Alzheimer Research Unit B. Lynn Beattie Ian R.A. Mackenzie G.-Y. Robin Hsiung Philip Lee Dean Foti Sherri Hayden Howard Feldman Sunsern Limsoontarakul Michele Assaly Phoenix Bouchard-Keer Alice Fok Sarah Le Huray Bonnie Leung Jonathan Money Benita Mudge Joanne Ng Pheth Sengdy Penny Slack William Wang Department of Computer Science Joanna McGrenere Matthew Brehmer Charlotte Tang Carmen Li Hyunsoo Li Students Amir Sepehry Jesse Ory Ralph Fisher & Alzheimer Society of BC Professorship in Alzheimer s Research Endowment Fund
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