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The following list provides a number of tests that can be used to screen for cognitiveimpairments in stimulant users. The first two can generally be administered by counselorswho are culturally competent for their client population. The other six tests should beadministered and interpreted by a psychological testing specialist.These tests can be administered quickly and easily and are used extensively in batteriescreated by neuro- and cognitive psychologists. Although the tests are very sensitive inrevealing the existence of cognitive problems, particularly when several of the tests areadministered in combination, they do not provide information on the exact nature or depth ofthe impairment.
Positive screens should be referred to an appropriate collaborator (e.g., aneuropsychologist) for more extensive assessments. Brief Neuropsychological Cognitive Examination(BNCE)This test is designed to evaluate the cognitive status of clients with psychiatricdisorders or psychiatric manifestations of neurological disease. The reading levelrequired for the test is minimal, and it is recommended for assessing mood disorders andsubstance use disorders. Both adolescents and adults can be tested in about 30 minutes.The BNCE is available from:Western Psychological Services12031 Wilshire BoulevardLos Angeles, CA1-800-648-8857. Backward Digital SpanThis test is simply saying numbers at the rate of one per second and asking the client torepeat them backwards. For example, you might say '3, 8, 6' and would expect a responseof '6, 8, 3.'
The examiner starts with three digits and goes up to nine digits. Threedifferent number strings are presented at each level. If the client misses all three ata particular level, then the test is stopped. This test takes about 5 minutes toadminister.
It is a test of working memory capacity. Repeated Memory Test (RMT)The RMT, which was developed by Sara L. Simon, Ph.D., has five different versions, eachequivalent in word frequency and length. Because the test is so simple, giving itmultiple times does not seem to involve a learning curve. Each test consists of 25 wordseach printed 3/4 inches high on a 3-inch x 5-inch card.The client is first told that she will be shown some words and that she will be asked toremember them. Then the words are presented to the subject, one at a time for 1 secondeach. When the client has seen all of the cards, there is an approximately 10-minuteinterval filled with distracter tasks.
During this interval, other tests-such as theDigit Symbol, Trail Making A, and Trail Making B tests-may be administered.The client is then given the recall test and told to write down any words that sheremembers. The client is allowed as much time as she needs to complete the test.However, if 2 minutes have gone by without the client responding, suggest that she stopbecause no one remembers them all.Next the client is given the recognition test and asked to circle the words that sheremembers being shown.A copy of the test follows, but for further information on the RMT, contactSara L. Simon, Ph.D.Los Angeles Addiction Treatment Consortium1001 W.Carson St., Suite U.Torrance, CA 90502310-2-782-9140 (fax).
Brief Neuropsychological Cognitive Examination (BNCE)J. Tonkonogy, M.D., Ph.D.This convenient test assesses the cognitive functions targeted in a typical neuropsychological exam. In less than 30 minutes, it gives you a general cognitive profile that can be used for screening, diagnosis, or follow-up. More efficient than a neuropsychological battery and more thorough than a screener, BNCE is an ideal way to evaluate the cognitive status of patients with psychiatric disorders or psychiatric manifestations of neurological diseases. Measure processing skills needed for everyday functioningAppropriate for individuals 18 years of age and older.The BNCE assesses. Working memory.
Gnosis. Praxis. Language. Orientation. Attention.
Executive functionsIt is composed of 10 subtests, none requiring more than minimal reading skills. Five of these subtests measure the ability to process conventional, frequently used information, while the remaining five measure the ability to process novel or incomplete information. The test focuses on processing skills needed for everyday functioning, and is sensitive to mild impairment often missed by other brief cognitive screeners. Find out how the patient processes novel versus conventional informationThe BNCE gives you subtest scores, a total score indicating overall severity, and two aggregate scores for the simple and complex subtests-so that you can look at the patient's ability to process conventional versus novel information. Results can help you differentiate problems caused by subcortical lesions from those caused by cortical lesions and those caused by primary psychiatric disorders. The BNCE Manual is unique in that it provides extensive guidance in interpreting test results. Quickly uncover cognitive abnormalitiesThe BNCE is an excellent way to start a process-oriented neuropsychological exam-It quickly reveals specific cognitive abnormalities that may warrant more detailed evaluation.
And it can be used to monitor the course of both psychiatric and neurological disease. It has been found especially useful in evaluating patients with sequelae of head injury, stroke, encephalitis, and primary degenerative disorders such as Alzheimer's, Huntington's, Parkinson's and Pick's diseases and those suffering from seizure disorders, schizophrenia, mood disorders, and alcohol and drug abuse. TRAINING 2019Mindmuzik Media is an HPCSA accredited training provider.
Welcome to contact Mindmuzik for more information:Technical SupportDo you need technical support with EAS or Career Mentor?Contact us via e-mail:Widely used to evaluate people with intellectual and developmental disabilities, the ABAS-3 assesses adaptive behaviour in individuals from birth to 89 years of age. It is particularly useful in evaluating individuals with developmental delays, autism spectrum disorder, intellectual disability, learning disabilities, neuropsychological disorders and sensory or physical impairments. PurposeSelection and recruitmentManagerial and professional developmentTeam profilesJob levelCognitively complex positions including professional and managerialNormsGeneralised norm58 defined norm groupsEstablish your own customised company specific normsAdministrationOnline only, no installation required.
Send personalised invitation email to acandidate and monitor progress.DeliverableGenerates comprehensive report per candidateSelector Insight Interview Questions based on test resultsTime45 to 60 minutes.
Understanding the neurological sources of individual differences helps identify brain-based disorders in attention, memory, personality, self-awareness (conscious experience), cognition, and emotional expression. Understanding these differences in learning can define current and future expectations in the lifestyle of the individual. Testing will give a comprehensive understanding of an individual’s strengths and impairments. We then create a of customized recommendations for therapy, treatments, educational assistance, and medic ations.Every brain is a unique puzzle of genetics (nature), experiences (nurture), physical health, learned responses, personality, injuries, and diseases. It is the role of a neuropsychologist to sort out the factors that influence how the brain is working in order to understand and explain abnormalities.The Neuropsychological Testing Process - Neuropsychological that may be givenNeuropsychological Testing vs. Standard Psychological TestingA standard psychological assessment typically evaluates general cognitive and personality functioning and is geared to diagnose psychiatric conditions. A standard assessment has the capacity to diagnose a condition such as ADHD based on behavior, but it lacks the specificity to understand what underlying neurological process is causing the symptoms and therefore cannot give customized recommendations for treatment.Neuropsychological assessment is a comprehensive assessment of cognitive processes.
We can evaluate neurological or neurodevelopmental disorders and understand the etiology and evolution of a disorder. Neuropsychology is the unique integration of genetic, developmental, and environmental history with testing data to better understand brain functioning. With a comprehensive assessment of a person’s cognitive and personality functioning, we can specify the origin and development of a disorder and customize recommendations. To understand cognitive strengths and weaknesses, neuropsychological testing further evaluates:.
Attention and concentration. Verbal and visual memory. Auditory and visual processing.
Visual spatial functioning. Language and reading skills. Sensory development and sensory integration. Gross and fine motor development. Social skill development. Executive functioning. Emotional and personality developmentCollateral information and behavioral assessment is sought from parents, educators, doctors, and therapists when appropriate.
IntroductionThe assessment of cognition is critical for the detection and differential diagnosis of dementias. It has important clinical implications for patient care, including access to treatment options, indicators for rates of survival, competency to drive and capacity to give informed consent, plus psychosocial factors such as whether patients are able to live independently at home, carer burden and quality of life. Shorter cognitive screening tests are particularly useful in a busy clinic where resources may not permit more comprehensive neuropsychological testing. The Addenbrooke's Cognitive Examination-III (ACE-III) and its predecessor, the ACE-R, are widely adopted and validated tools currently used in memory clinics and dementia research around the world ,. They are useful in the detection and differentiation of dementia subtypes ,.
The ACE-III is the latest version of the ACE, which has been validated against formal neuropsychological tests. It is scored out of 100 and includes items assessing the domains of attention, memory, fluency, language and visuospatial function. However, it is a test that requires at least 15-20 min to administer which is beyond the scope of many clinical settings. The aim of this study was to derive a shorter version of the ACE-III, the Mini-Addenbrooke's Cognitive Examination (M-ACE), using a data-driven scaling method, to validate this new instrument in patients with a range of dementia syndromes and to compare the M-ACE with the widely used commercially available Mini Mental State Examination (MMSE). ParticipantsParticipants were recruited from the Frontier Research Group, Sydney, N.S.W., Australia, the Memory Clinic of Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom and the Oxford Cognitive Disorders Clinic, Oxford, United Kingdom. Patients were assessed in multidisciplinary teams including an experienced behavioural neurologist, and diagnosis was made in line with current diagnostic criteria , according to the clinical assessment, comprehensive neuropsychological assessment and structural brain imaging.
Controls were recruited from a healthy volunteer panel. Exclusion criteria for controls were the presence of significant neurological conditions (e.g., epilepsy), current psychiatric illness (e.g., depression) and significant drug and alcohol history. Derivation of the M-ACEMokken scaling analysis was used to examine the hierarchy of items on the ACE-III and derive the M-ACE. This technique provides an indication of test item difficulty and discriminatory ability. Ideally, a sound instrument consists of items covering a wide range of difficulty levels with high discrimination.
Briefly, Mokken scaling analysis first seeks unidimensional sets of items based on several scalability coefficients first introduced by Loevinger. For the entire set of items, there is a test scalability coefficient (H), for each item within a test there is an item scalability coefficient (H i) and for each item pair an item pair scalability coefficient (H ij). H is a measure of the extent to which pairs of test items completed by the participant appear in the same relative order which ranges from 0 (no scalability) to 1 (perfect ordering) and 0.3 is generally taken as minimum value for a Mokken scale. A set of items form a Mokken scale provided all item scalability coefficients are greater than 0.3 and for all item pairs, the item pair scalability coefficient is a positive value. Next, Mokken scaling analysis identifies items that conform to the monotone homogeneity model (MHM). Scores on items conforming to this model increase as the level of the latent trait (e.g., cognitive ability) increases and items that do not meet the MHM criteria can be removed. Once items fit the MHM, H i can be interpreted as a measure of the items discrimination with higher values indicating greater discrimination.
Finally, unidimensional sets of items meeting the MHM criteria can be examined for invariant item ordering (IIO), which is necessary in the development of hierarchies that are replicable across samples. Invariantly ordered items are also responded to in the same order by all respondents regardless of the participant's level of cognitive ability. IIO identifies items with item response functions that do not overlap. The H-trans (H T) refers to the distance between the item response functions with higher values indicating greater IIO accuracy.Itemized ACE-III data from 117 patients behavioural variant frontotemporal dementia (bvFTD), n = 25; primary progressive aphasia (PPA), n = 49; Alzheimer's disease (AD), n = 34; corticobasal syndrome (CBS), n = 9; mean age = 65.5 ± 8.2 years; mean years of education = 12.4 ± 3.1 were used for Mokken scaling analysis. The mean score of each ACE-III item was divided by the maximum number of points available for that item to equate scores across all of the items for comparison purposes e.g., a mean score of 3.97 for ‘orientation to time’ was divided by the maximum score possible for that item (5) to produce an equated mean of 0.74. See online supplementary table (see for all online suppl.
Material) for the complete list of equated means in the patient cohort. ‘Naming’, which is scored from 0 to 12, was rescaled to 0-9 as this method does not accommodate values above 9.
Data were entered into the freeware R environment using the ‘Mokken’ package.First, examining the unidimensionality of the data showed that all item pair scalability coefficients (H ij) were positive. The H i values of 5 of the 24 ACE-III items fell below the 0.3 threshold level (‘repetition of single multisyllabic words’, ‘perceptual dots’, ‘overlapping infinity loops’, ‘single word reading’, ‘drawing of a cube’) and were excluded.
The remaining 19 items yielded a combined H of 0.45. Second, no items were excluded in the assessment of monotonicity. Finally, in the assessment of IIO, 2 items (‘syntactical comprehension’ and ‘3-item registration’) were removed. The remaining 17 items formed a moderate hierarchical Mokken scale (H = 0.44) with IIO (H T = 0.61) (see table in online suppl. From these 17 items, 5 items were selected based on a conceptually driven decision to cover the main cognitive domains. These include: orientation to time, learning and recall of the name and address, animal fluency and drawing of a clock face to command with time specification (ten past five o'clock).
The selected items range in difficulty where equated means scores ranged from 0.33 (most difficult) to 0.78 (least difficult) (see table in online suppl. The items also have high discrimination (H i = 0.42-0.52). Within the orientation items, ‘season’ was removed as this particular question is known to be difficult to answer in some regions (e.g., tropics). These 5 items together form the M-ACE, which has a maximum score of 30 with higher scores indicating better cognitive function. Data Analyses for Validation of the M-ACE and Comparisons with the MMSEData were analysed using IBM SPSS (Version 20). Non-parametric tests were carried out as data were non-normally distributed. In all analyses, a conservative threshold of p 4.12), mild (4.11-1.92), moderate (1.91 to −0.40), severe (−0.39 to −2.58), very severe (−2.57 to −4.99) and profound (below −4.99).
All patients in the validation sample had logit scores -0.39. First, demographic data (e.g., age, education, dementia severity and ACE-R scores) were examined in the validation sample. Then, M-ACE scores were obtained from items within the ACE-R. Scoring for orientation was modified from 0-5 to 0-4 (because of the removal of the ‘season’ item) as follows: 5 = 4, 4 = 3, 3 = 2, 2 = 1, 1 and 0 = 0. Group comparisons were made on the M-ACE and MMSE using the Kruskal-Wallis test with post hoc analyses carried out using the Mann-Whitney U test.
Correlations between the M-ACE, MMSE and FTDFRS were examined using Spearman's correlation coefficient. Sensitivity, specificity, and positive and negative predictive values were calculated using discriminant analyses for the M-ACE and MMSE. Finally, the M-ACE consists of items assessing 4 main cognitive domains: orientation (to time), memory (learning and recall of the name and address), language (fluency) and visuospatial function (drawing of a clock face). Group differences were examined for percentage correct scores for each cognitive domain. For memory, the total percentage correct scores were calculated by summing up the points obtained for both learning and recall conditions. The MMSE consists of items assessing similar cognitive domains: orientation (to time and place), attention (serial 7s), memory (learning and recall of 3 items), language (written instruction, 3-stage command, sentence writing, repetition and naming) and visuospatial function (drawing of pentagons).
Group differences were also examined for percentage correct scores for each of these domains on the MMSE. ResultsDemographic data for the validation sample (n = 242) are given in table. Groups were matched for age (p = 0.02), years of education (p 0.10) and years since symptom onset (p 0.10). Disease severity, as indicated by the FTDFRS, was greater in the bvFTD than PPA group (p.
1Lower scores reflect greater dementia severity.As shown in figure, comparisons of the patient groups' performance on the M-ACE and MMSE indicated that all patient groups were impaired on both tests when compared to controls (p. Performance on the M-ACE ( a) and MMSE ( b) of the patient groups and controls. Maximum and minimum scores are displayed on the box-and-whiskers graphs. All patient groups scored significantly lower than controls (p 5 times more likely to have come from a patient with dementia than without. A lower cut-off of ≤21/30 has a positive predictive value of 1.0 regardless of the prevalence, which means that a score of 21 on the M-ACE is almost certainly from a patient with dementia regardless of the clinical setting (table ). Cut-offM-ACEMMSEsensitivityspecificityPPV (NPV)LR+sensitivityspecificityPPV (NPV)LR+291.000.170.72 (1.00)1.200.950.460.79 (0.80)1.76280.980.400.77 (0.91)1.630.820.790.89 (0.67)3.98270.930.630.84 (0.80)2.490.720.960.98 (0.890.830.92 (0.78)5.340.631.001.00 (0.56)100250.850.870.93 (0.74)6.660.521.001.00 (0.50)100240.790.910.95 (0.67)8.760.441.001.00 (0.46)100230.730.970.98 (0.63)28.30.371.001.00 (0.43)100220.650.990.99 (0.57)50.90.271.001.00 (0.40)100210.611.001.00 (0.55)1000.221.001.00 (0.38)100.
A typical memory clinic would have a prevalence of at least 50%.Profiles across dementia syndromes considering the main cognitive domains were examined for the M-ACE and MMSE. Percentage correct scores are displayed in figures.
First, comparisons among the dementia cohorts for the M-ACE showed that the AD group was impaired on the orientation items compared to the bvFTD and CBS groups (p. Performance on items of the MMSE of the patient groups and controls.
Maximum and minimum values are displayed on the box-and-whiskers graphs. Significant differences between patient groups are indicated with capped lines. Graphs for the attention domain (serial 7s) were not included as non-significant group differences were obtained between dementia groups.
Significant differences between patient groups and controls are indicated below the control group. DiscussionWe introduce the M-ACE, a very brief and sensitive cognitive screening tool for dementia that was derived from a data-driven scaling method. It has a maximum score of 30 with higher scores indicating better cognitive function and contains items assessing 4 main cognitive domains: orientation, memory, language and visuospatial function. Two cut-offs are suggested for clinical use or screening of patients for research. First, the higher cut-off of 25/30 has both high sensitivity and specificity and is at least 5 times more likely to have come from a patient with dementia than without.
A lower cut-off of 21/30, by contrast, is almost certainly diagnostic of a dementia syndrome regardless of the prevalence rate. The M-ACE takes under 5 min to administer and, like the ACE-III, can be downloaded from.The M-ACE has many advantages in a clinical setting.
Like the MMSE, it is short and allows for the rapid assessment of patients. It contains items which are easily translated into non-English languages and does not require formal specialized training for administration or scoring.
A major benefit, we feel, is the fact that the M-ACE was empirically determined and is comprised of items which are within both the ACE-III and its predecessor, the ACE-R, enabling clinicians to derive M-ACE scores from pre-existing patient data. The M-ACE was highly intercorrelated with the MMSE despite the small overlap in orientation items only. Analyses of sensitivity and specificity indicated that at all cut-offs, the M-ACE has greater sensitivity but somewhat less specificity than the MMSE. The M-ACE is, therefore, more sensitive at detecting individuals with cognitive impairment. However, impairment on test scores needs further evaluation before a dementia diagnosis is given. An additional benefit of specificity being 1.0 at the lower cut-off of 21 on the M-ACE is that this test is less likely to have ceiling effects, which are a common problem for short cognitive screening tools, and is therefore likely to be particularly useful when examining and monitoring patients in a clinical setting who have milder cognitive impairments.Cognitive screening tools, such as the M-ACE or MMSE, do not replace the comprehensive medical, sophisticated neuropsychological and neuroimaging techniques that is required for the differential diagnosis of dementias. However, examination of total scores on the M-ACE produces somewhat distinctive cognitive profiles across not only AD and FTD variants but also CBS and replicates previous literature ,.
On the M-ACE, bvFTD and CBS patients both obtained higher scores than AD and PPA patients. This probably reflects the fact that a large component of the M-ACE is driven by language and verbally based (learning of name and address) items. Second, domain scores on the M-ACE showed that AD patients are impaired on tests of orientation, patients with progressive aphasias are least able to generate words on the fluency task, and drawing of a clock face is most difficult domain for the CBS cohort. While differing group profiles also emerged for the MMSE, the M-ACE was better able to differentiate dementia groups in the domains of memory and language, which are particularly important for the assessment of AD and FTD syndromes.Symptom duration was matched across the dementia cohorts with patients exhibiting symptoms for approximately 3-4 years prior to a dementia diagnosis. On the FTDFRS, a dementia staging tool based on everyday functional abilities and behavioural symptomatology, patients in this study were rated as having mild to moderate stages of dementia.
Items assessing behaviour are likely to explain why the patients with bvFTD - a syndrome characterized by striking disturbances of behaviour (disinhibition, apathy, etc.) - were rated significantly worse on the FTDFRS than the patients with PPA, a syndrome with striking language impairments particularly in the early stages of the disease. The M-ACE is a cognitive screening tool with a heavy emphasis on verbally mediated and language items. Not surprisingly, therefore, the M-ACE showed a weak association with the FTDFRS. These findings have important clinical implications. An individual with high scores on the M-ACE may in fact be in the moderate stages of dementia with significant behavioural abnormalities and functional impairments that greatly affect carer burden and may require additional medical intervention and social support services.This study has some limitations. The M-ACE was derived using patients from specialized or tertiary hospital clinics.
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The applicability of the M-ACE in a community setting should be evaluated as the prevalence of dementia differs considerably and cases with mixed aetiologies are more common. Similarly, exploring the effects of age, education and sex on M-ACE scores in a population-based cohort would be valuable. Performance of patients with neurodegenerative conditions which have milder cognitive impairments should also be examined.
Scores on memory items on the M-ACE were obtained from the ACE-R but the delay between learning and recall of the name and address is, however, longer in the ACE-R than the M-ACE. It is very unlikely that this will affect memory scores, particularly for patients with AD, as poor retention of new material is known to exist even after a very short interference task in AD ,. A screening tool for executive functioning or carer-based questionnaires assessing behavioural symptomatology (e.g., disinhibition, apathy, and change in eating habits) would be useful in addition to the M-ACE when examining patients suspected of having bvFTD. Also, the utility of the M-ACE in differentiating between PPA subtypes (semantic variant, logopenic variant and non-fluent variant) is an area for further research.
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The M-ACE in conjunction with more specific tests of language functioning - such as the Sydney Language Battery - are likely to be particularly useful in the context of assessing PPA patients in a clinical setting. Finally, while comparisons were made with the MMSE, the M-ACE should also be evaluated against other brief and freely available cognitive screening tools for dementia, such as the Montreal Cognitive Assessment.The M-ACE is a brief cognitive screening tool.
It has a maximum score of 30 with two cut-offs: 25 and 21. The M-ACE is highly sensitive to cognitive impairment and is less likely to have ceiling effects with a specificity of 1 being obtained at the lower cut-off.
In addition, total and domain scores on the M-ACE offer somewhat distinctive profiles across FTD variant, AD and CBS syndromes, which might be useful for the differential diagnosis of dementias in a clinical setting. The authors are grateful to the participants and their families for supporting our research.This work was supported by funding to Forefront, a collaborative research group dedicated to the study of frontotemporal dementia and motor neurone disease, by the National Health and Medical Research council (NHMRC) of Australia program grant (1037746) and the Australian Research Council (ARC) Centre of Excellence in Cognition and Its Disorders Memory Node (CE110001021). Is supported by the Graham Linford Fellowship from the Motor Neurone Disease Research Institute of Australia. Is supported by Alzheimer Scotland (PhD Studentship). Is supported by an Australian Postgraduate Award (PhD Scholarship). Is supported by NIHR Cambridge Biomedical Research Centre.
Is supported by the NIHR Biomedical Research Centre, Oxford. Is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/K010395/1). Is supported by the Wellcome Trust (088324), Medical Research Council, McDonnell Foundation and the NIHR (Cambridge Biomedical Research Centre and Biomedical Research Unit in Dementia).
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Is supported by the NHMRC Early Career Fellowship (1016399) and Alzheimer Association USA. Is supported by an ARC Federation Fellowship (FF0776229).
TRAINING 2019Mindmuzik Media is an HPCSA accredited training provider. Welcome to contact Mindmuzik for more information:Technical SupportDo you need technical support with EAS or Career Mentor?Contact us via e-mail:Widely used to evaluate people with intellectual and developmental disabilities, the ABAS-3 assesses adaptive behaviour in individuals from birth to 89 years of age. It is particularly useful in evaluating individuals with developmental delays, autism spectrum disorder, intellectual disability, learning disabilities, neuropsychological disorders and sensory or physical impairments. PurposeSelection and recruitmentManagerial and professional developmentTeam profilesJob levelCognitively complex positions including professional and managerialNormsGeneralised norm58 defined norm groupsEstablish your own customised company specific normsAdministrationOnline only, no installation required. Send personalised invitation email to acandidate and monitor progress.DeliverableGenerates comprehensive report per candidateSelector Insight Interview Questions based on test resultsTime45 to 60 minutes.
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