Improving Cognitive Assessment in the Context of Rural Dementia Diagnosis'
Date
2025-01-14
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
ORCID
0000-0002-1153-5655
Type
Thesis
Degree Level
Doctoral
Abstract
Cognitive assessment is an essential part of dementia diagnosis, but traditional assessment methods are challenging to use in rural areas. Promising remote assessment alternatives include telephone-based cognitive tests and self-administered computerized cognitive tests. These methods can benefit primary care providers and dementia specialists serving rural-dwelling patients by increasing access to assessment results, but this increased access also may degrade diagnostic decision making if the instruments are biased and their use increases. While research comparing the measurement equivalence of cognitive assessment instruments in rural versus urban populations is limited, there is some evidence of bias with respect to rural residence. Possible sources of bias include differences in educational experiences, cognition, and culture. Important groundwork is missing to ensure traditional and new cognitive assessment methods are valid with rural-dwelling populations. Three studies presented here address this gap by investigating the psychometric properties of cognitive assessment instruments in rural and urban populations. The first study examined the measurement equivalence of a traditional cognitive assessment instrument, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in a mixed urban and rural population. This study used a multigroup confirmatory factor analysis and found no evidence of measurement bias with respect to rural/urban residence, providing evidence that some traditional cognitive assessment instruments function similarly in rural- and urban-dwelling populations. The second study also investigated the measurement equivalence with respect to rural/urban residence of a telephone-based cognitive assessment instrument, the Canadian Longitudinal Study on Aging – Cognitive test (CLSA-Cog). Unlike the first, there was evidence of a small bias with respect to urban/rural residence on tasks related to executive functioning. The third study documented the development of a scoring algorithm for a self-administered computerized cognitive assessment instrument, the Computerized Assessment of Memory and Cognition (CAMCI). While the instrument initially appeared promising, in the process of developing a scoring algorithm for the device, it became apparent that the diagnostic accuracy statistics reported by the test developers were likely inflated. Together, these studies support the use of traditional and novel cognitive assessment instruments in rural populations, while highlighting the challenges of dementia research in rural populations, particularly with respect to non-traditional cognitive assessment methods.
Description
Keywords
Dementia, Neuropsychology, Rural
Citation
Degree
Doctor of Philosophy (Ph.D.)
Department
Psychology
Program
Psychology