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European Standardised Process Approach to Cognitive Evaluation in older people

Periodic Reporting for period 1 - E-SPACE (European Standardised Process Approach to Cognitive Evaluation in older people)

Reporting period: 2016-02-01 to 2018-01-31


Cognitive evaluation is important for early and accurate dementia diagnosis. However, currently available cognitive tests, particularly brief screening tests, are not always reliable in detecting the earliest stages of cognitive decline.

This project aimed to improve current measures, using a process-based approach to cognitive assessment, as cognitive testing will be incomplete if it relies on summary scores alone and does not take account of other aspects of test performance.

Typically, cognitive evaluation pays attention only to “what” one does (i.e. test scores). Above a certain score or cut-point (e.g. ≥24/30), the person may be considered “healthy” and below that cut-point (≤23) there could be suspicion of cognitive deterioration. However, people with high education levels may perform above the cutoff and look “healthy” when they may not be and people with low education levels may perform poorly despite being cognitively healthy. Misclassification can result in failure to detect deterioration or in classifying someone as impaired when they are not. Both scenarios highlight the need to improve tests to ensure early and proper diagnosis.

Importance for society:

The benefits of early and accurate diagnosis of Mild Cognitive Impairment and/or dementia include the fact that the person may still be able to participate actively in care planning and in decision-making about important issues like drug treatments, legal and financial affair management and service options. Early and correct diagnosis can also enable the person and family members to adjust and adapt. This may improve quality of life and reduce stress. Furthermore, at a societal level, timely diagnosis can reduce healthcare costs by delaying nursing home admission.

Project objectives:

The main goal of this project was to review existing screening tests and, where possible, to improve those measures to provide clinicians with better tools for early and accurate diagnosis.

Conclusions of the Action:

We identified and developed two test batteries that allow clinicians perform a brief cognitive assessment. Tests are administered in the usual manner, but the clinician now pays attention to the person’s answers and registers them verbatim so that answers and errors can be examined in detail.
After review of the existing literature on cognitive screening, we published two articles where the theoretical aspects of the project are presented.

Based on this work, we recognised that two widely used screening tests (MoCA, ACE-III), might benefit most from modification using a “process-based” approach.

In year 1, work with healthy older volunteers helped to determine the responses, errors, and behaviours shown by participants when completing these tests. With this information, changes were made to these tests to increase the amount of information that can be collected in a single short session. Testing of older adults, both healthy and clinical, using these modified tests was then extended in Ireland and internationally (Spain and USA).

In Ireland, the modified MoCA (MoCA-PA) is now being used in two specialist memory clinics, with further test-sites due. Psychology staff from University of Salamanca (Spain) are now developing a Spanish version of MoCA-PA, testing a large sample of healthy older adults. In the USA, contacts with neuropsychologists Dr. David Libon and Dr. Melissa Lamar have enabled MoCA-PA to be piloted with a mixed clinical sample. We are also in the process of test computerisation in collaboration with a company in the Netherlands that developed an open platform for test computerisation.

This extension of our network and resources has extended the studies with clinical samples amd ongoing studies in Ireland, Spain and the USA will yield results on the utility of these modified versions of tests - with several publications expected in high-impact journals in 2018-19.

Project publicity was achieved via presentations at national and international conferences, and through invitations to speak at a number of lay and scientific meetings. The main targeted international events were the International Neuropsychological Society (INS) Conference (London, July 2016; New Orleans, Feb 2017) and the 6th Meeting of the Federation of the European Societies of Neuropsychology (Sept 2017). Nationally, the main event was the Psychological Society of Ireland Annual Meeting (Nov 2016 & 2017). We also expect to present a symposium at the upcoming INS meeting (Prague, July 2018).

Presentations to the public included an online talk for Supercuidadores, an online education and learning platform for informal caregivers in Spain (April 2016); the Intergenerational Learning Centre in DCU (Sept 2016), an online Openclass to students and the public at UNIR university (Sept 2017) and the European’s Researchers Night, Trinity College Dublin (Sept 2017). Other presentations to the public are scheduled for 2018 (e.g. DCU Mental Health Public Series – May 9th 2018).

Guest lectures, manuscript preparation for high-impact peer-reviewed journals, and the production of high quality scientific presentations was intended not only to publicise the findings of the project but also to provide the Research Fellow with a wider network of professional contacts that will help him develop his career further. Here, the networking activities between the E-SPACE team and other professionals in Europe and the USA have exceeded the initial Fellowship expectations and will ensure that the work started with the E-SPACE project will continue to expand. A series of lectures, conferences and events are now planned over 2018 and 2019 that will ensure the continuity of this work and ensure the extension of its impact. Project progress and additional dissemination activities will be updated regularly through the project’s website which will be kept alive to further inform about post-project developments.

In summary, the E-SPACE project has provided the Fellow with the opportunity to enhance his reputation and connections within the scientific community. Based on his growing reputation as a world-class researcher, he has now secured a permanent position as a Lecturer in Psychology at Maynooth University (MU, Ireland). In addition, because of his reputation, he was invited to participate in a successful H2020 proposal (as Irish Lead investigator) ( where he will now represent MU.
E-SPACE represents the first attempt to employ a process-based approach to cognitive screening tests for MCI and dementia. The project has increased awareness among professionals, academics, clinicians and students (future professionals) of the benefits of a qualitative, process-based approach to cognitive screening, has increased the utility of existing cognitive screening tests (by providing clinicians the opportunity to obtain more accurate information from their patients in, more or less, the same time) and will increase, we believe, the attention paid by clinicians to the rich data than can be obtained from these purportedly simple cognitive tools. Additional test validation will, in due course, improve diagnostic accuracy and timing.