Clinical Interventions in Aging 2015:10 1881–1887

Visual-spatial perception: a comparison between instruments frequently used in the primary care setting and a computerized cognitive assessment battery

 

Boris Punchik MD, Avital Shapovalov MD, Tzvi Dwolatzky MD, Yan Press MD.

Comprehensive Geriatric Assessment Unit, Clalit Health Care Services, and Center for Multidisciplinary Research in Aging, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

 

Abstract 

Cognitive decline associated with advancing age is one of the most important challenges currently facing health care providers. The spectrum of neurocognitive decline from subjective cognitive complaints to mild cognitive impairment (MCI) and ultimately to a progressive dementia syndrome places the primary care physician at the forefront in providing care for a growing number of cognitively impaired older patients. MCI is a clinical syndrome that is prevalent in the older population, with some 15% of those older than 65 years having this condition, with a range of 3%–42% reported in community-based studies. Approximately 10% of patients with MCI will progress to dementia annually.

In a previous studies it was shown that changes in visual-spatial perception sometimes appear in the preclinical phase of dementia as early as 3 years before the diagnosis of dementia. The purpose of this study was to examine whether the use of visual-spatial perception testing (as a component of existing screening tools for the early detection of cognitive impairment) is of value for the determination of cognitive impairment.

Cognitive screening and assessment included visual-spatial components: the Mini Mental State Examination (Pentagon copying), the Clock Drawing Test, the Montreal Cognitive Assessment Test( Cube copying and Trail Making B Test), and the Neurotrax (Mindstreams) computerized cognitive assessment battery as Gold Standart. The high sensitivity found for the combination of all four tests that were administered was associated with a low specificity. Our results suggest that when at least one of the tests is abnormal, it is suspected for cognitive decline and further cognitive assessment is indicated.

 

Supplement

The incidence of cognitive decline in the elderly population increases with age. There are many methods for early detection of cognitive decline in the population, but most of them take a long time, require preliminary knowledge and additional staff. Evaluation of visual spatial perception for screening of mild cognitive impairment as an independent method was not used, although most existing methods use a visual spatial perception test as part of a comprehensive cognitive assessment. We wanted to create a simple, short test, which can be performed by staff (not doctors), which has high sensitivity and the ability to diagnose the need for further cognitive evaluation.

To the best of our knowledge, this is the first such study to evaluate the combined value of screening tests for visual-spatial ability in cognitive assessment.

The importance of this study:

  1. The study shows that the combination of four simple, short tests of  visual spatial perception was highly sensitive for early detection of mild cognitive impairment.
  2. The time required to administer these four tests varied from 3 to 5 minutes, which is certainly acceptable for screening. These tests are all simple paper-based tests that can be easily administered in the clinic or home setting by medical staff who have received the necessary training.

 

 

fig1

Figure 1. Components of combined visual spatial perception test.

 

Reference 

  1. Punchik BPI, Shapovalov A, Dwolatzky T, Press Y. Visual-spatial perception: a comparison between instruments frequently used in the primary care setting and a computerized cognitive assessment battery. Clin Interven Agin 2015:10 1–7

 

fig2Contact: 

Boris Punchik, MD

Comprehensive Geriatric Assessment Unit,

Clalit Health Care Services, Yassky Clinic,

24 King David Street, 84539, Beer Sheva, Israel

E-mail:borispu@clalit.org.il

 

 

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