Question
What should clinicians consider when selecting a comprehensive test battery to assess mild cognitive impairment?
Answer
The screening tools I have described help you determine what matters most and begin to understand the individual’s experience. But I want to be clear: these are not full standardized objective cognitive assessments. If you are looking to formally classify someone as having MCI, you need to use a comprehensive test battery. The literature offers some key recommendations to guide that choice (McCullough, Bayles, & Bouldin, 2019).
First, use an assessment with normative data. This is non-negotiable because normative data increases your ability to make valid judgments about whether a person’s performance is atypical for their age and education. Without normative comparison data, it is genuinely difficult to identify what is atypical. With MCI, the performance decrements are often subtle.
Second, use a comprehensive battery that assesses multiple cognitive domains. Because multi-domain impairment is associated with higher conversion risk, seeing patterns across multiple domains is clinically meaningful. When you see lower levels of performance across several measures and in more than one cognitive domain, you can feel more confident in an MCI diagnosis.
Third, use measures with a gradient of difficulty. This is what enables you to detect subtle impairments. If all items on a test are the same difficulty level, you will miss the nuanced performance differences that distinguish MCI from normal aging.
Fourth, assess episodic memory. Alzheimer’s disease is the most common cause of MCI and dementia, and its signature characteristic is episodic memory loss, specifically, rapid forgetting. Clinicians should therefore include an objective assessment of memory in both immediate and delayed recall conditions. Seeing how much a person retains after a delay is one of the most clinically informative data points you can have.
This Ask the Expert is an edited excerpt from the course, Mild Cognitive Impairment (MCI): Assessment and Treatment, presented by Kim McCullough, PhD, CCC-SLP.
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