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Cognitive Assessment for the Ages

Posted Jul 25 2011 9:02am

Dr. Ralph Kiernan Ralph J. Kiernan, PhD presented a webinar on Cognistat–a more customized cognitive assessment. The seminar, offered through the American Society on Aging, was enlightening considering the major role the Mini-Mental State Exam still plays. I invited Dr. Kiernan to write an article for TheCaregiversVoice.com’s professionals and encourage family caregivers to also be familiar with this tool.  (TCV Ed.)

by Ralph J. Kiernan, PhD

Brain fitness is an index of general health that can be monitored over time through cognitive assessment. Regular cognitive evaluations with brief screening examinations can identify mild cognitive impairment in its early stages. This provides a basis for making appropriate referrals for further evaluation and allows treatment to be offered before a condition becomes advanced.

A cognitive screening instrument needs to include certain features in order to evaluate the geriatric population effectively. The assessment has to be brief, but it cannot sacrifice either sensitivity or specificity. Tests that generate a single global or summed score attain their sensitivity through an over-reliance on sustained attention and lose specificity. Screening tests, therefore, need to evaluate cognition in specific cognitive domains or ability areas so that they can generate a differentiated array of scores. Within the limits of cognitive screening, these tests should provide a measure of performance using age-based normative data.

Cognistat and CAS highlight both situational factors and medications that have a high potential for affecting cognition.

My colleagues and I developed Cognistat and the Cognistat Assessment System (CAS) to meet these requirements. Cognistat and CAS generate a profile of cognitive strengths and weaknesses (abilities and disabilities) in each of the major ability areas. The profiles illustrate general functioning in Attention and Orientation as well as specific abilities in three aspects of Language, Constructional Ability, Memory, Calculations and two types of Reasoning. These profiles provide a snapshot of brain fitness at a given point in a patient’s life.

The geriatric population is particularly vulnerable to situational factors such as loss, depression, uncertainty and anxiety. Many instances of cognitive decline in the elderly are due to medication side effects. Cognistat and CAS highlight both situational factors and medications that have a high potential for affecting cognition.

In order to monitor brain fitness over time, a well-maintained record keeping system is essential. The online Cognistat Assessment System includes an electronic central data storage system that provides a secure data repository. All identifying patient information is maintained locally at each user site. This information can be used to track patients over time, to make data and profile comparisons and to conduct research on specific patient populations. The online system is ideal for clinics with multiple users and for central agencies that supervise cognitive assessments at multiple remote sites

Dr. Ralph Kiernan (PhD) is a clinical neuropsychologist who has practiced in the San Francisco Bay area for more than 37 years. He is one of the central creators of Cognistat, and he has been closely involved in the development of the new online assessment system. His clinical specialty is mild traumatic brain injury.

 

 

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