Doctoral Dissertations

Date of Award

12-2000

Degree Type

Dissertation

Degree Name

Master of Arts

Major

Psychology

Major Professor

Michael G. Johnson

Committee Members

William H. Calhoun, Warren H. Jones

Abstract

Dementia is a major public health challenge, which is becoming more common as the aged population grows. Adequate care of dementia patients requires that they be recognized as having memory impairment, identified as having dementia syndrome, and evaluated for the specific cause of the dementia. Dementia is one of the first symptoms in the beginning stages of Alzheimer’s disease. Currently, the most common psychological instrument used in early evaluation of dementia and other cognitive problems in Alzheimer’s disease is the Mini Mental Status Exam (MMSE, Folstein & Folstein, 1974). The MMSE evaluates different aspects of a patient’s memory, visuospatial functions, as well as patients’ orientation. One school of thought suggests older persons who develop Alzheimer’s disease usually linger first in a transitional stage called mild cognitive impairment, or MCI (Petersen, 1999). Researchers from the Mayo Clinic report that primary care physicians who suspect patients may be experiencing such decline can identify them with commonly used cognitive tests. Early identification is important because persons with mild cognitive impairments are at risk for developing Alzheimer’s disease and might be candidates for interventions that could prolong the progression of dementia.

In order to improve discrimination in screening for cognitive impairments in Alzheimer’s disease, we developed a new four-item brief cognitive test called the Self Test. The purpose of the study is to evaluate the reliability, validity, specificity, as well as sensitivity of the Self Test. The Self Test evaluates not only memory, but more carefully assesses aspects of visuospatial function. In addition, in a concise form, it uses verbal fluency as an important test of early cognitive impairment as well. The Self Test uses controlled learning to ensure attention, induce specific semantic processing, and optimize encoding specificity of verbal fluency and visuospatial skills to improve detection of cognitive deficits. Furthermore, this test has been constructed such that patients with mild to moderate disease can administer the test themselves; therefore, it is called the Self Test. Patients with more severe impairment do require some assistance with instruction, and a family member or untrained personnel can help administer this test quite easily. The Self Test provides an efficient, reliable, and valid screening for cognitive impairments in the early stages of Alzheimer’s disease compared to the MMSE. Additionally, the Self Test is constructed in such a way that patients with mild to moderate cognitive impairments can administer the test themselves, in the presence of family members, or other untrained personnel, which makes the Self Test particularly suitable for use in the primary care settings. The Self Test is a new screening test for cognitive impairments in early Alzheimer’s disease that is brief, easy to use, and shows high reliability and validity.

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