The Future of Cognitive Screening in Neurodegenerative Diseases

Article type: Review Article

Authors: Umfleet, Laura Glass^{a; *} | Bilder, Robert M.^b | Loring, David W.^{c; d} | Thames, April^b | Hampstead, Benjamin M.^{e; f} | Bauer, Russell M.^g | Drane, Daniel L.^{c; d} | Cavanagh, Lucia^b

Affiliations: [a] Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA | [b] Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA | [c] Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA | [d] Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA | [e] Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA | [f] Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA | [g] Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA

Correspondence: [*] Correspondence to: Laura Umfleet, PsyD, ABPP-CN, Associate Professor of Neurology, Division of Neuropsychology, Medical College of Wisconsin, 8701W Watertown Plank Rd, Wauwatosa, WI 53226, USA. Tel.: +1 414 955 0660; E-mail: lumfleet@mcw.edu.

Abstract: Cognitive screening instruments (CSI) have variable sensitivity and specificity to the cognitive changes associated with dementia syndromes, and the most recent systematic review found insufficient evidence to support the benefit of cognitive screening tools in older adults residing within the community. Consequently, there is a critical need to improve CSI methods, which have not yet incorporated advances in psychometrics, neuroscience, and technology. The primary goal of this article is to provide a framework for transitioning from legacy CSIs to advanced dementia screening measurement. In line with ongoing efforts in neuropsychology and the call for next-generation digital assessment for early detection of AD, we propose a psychometrically advanced (including application of item response theory methods), automated selective assessment model that provides a framework to help propel an assessment revolution. Further, we present a three-phase model for modernizing CSIs and discuss critical diversity and inclusion issues, current challenges in differentiating normal from pathological aging, and ethical considerations.

Keywords: Alzheimer’s disease, cognitivescreening instruments, dementia, neuropsychology

DOI: 10.3233/JAD-221077

Journal: Journal of Alzheimer's Disease, vol. 93, no. 1, pp. 47-59, 2023