Date of Award

2000

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Master of Psychology

Faculty

Faculty of Community Services, Education and Social Sciences

First Supervisor

Associate Professor Ed Helmes

Abstract

Dementia is a growing social problem in Australia because as the population ages, the incidence of dementia increases. While the prevalence rates are only about I% at age 65, they double every five years until by 85 years of age the rate is over 24%. It is expected that by the year 2030, the number of elderly people with dementia will increase by 200%. Dementia is easily recognized in its advanced stages but can be overlooked in the early phase. Family members, care-givers and even the treating medical practitioner may mistakenly attribute the early decline in mental function to the normal aging process. A diagnostic instrument that is easy to administer and score yet is sensitive and specific to the detection of cognitive impairment in the elderly may prove to be of significant benefit to clinicians and assist care-givers and family members in treatment decisions, accommodation requirements and the timely provision of a range of support services. This study investigates the use of the Cognitive Status Examination (CSE) for detecting brain impairment in elderly people. The Cognitive Status Examination comprises the Cognitive Difficulties Scale and a Letter Symbol Substitution Task. It was developed as a screening instrument to detect Alcohol Related Brain Impairment and has proved to be 80% sensitive and 88% specific in detecting brain impairment in that group. This study extended those results to males and females aged 65 years and over with early dementia. A sample of 58 community-dwelling, elderly people aged 65 years and above and a clinical sample of 44 in-patients who were diagnosed with early dementia completed the Cognitive Status Examination. An existing groups, quasi-experimental research design was used. The Cognitive Status Examination proved to be marginally useful as a screening instrument for detecting cognitive impairment in elderly people with early stage dementia with a sensitivity of 59% and a specificity of 93% when the original cut-off scores were used. A revised cut-off score, determined by trial and error, was developed. This resulted in a sensitivity of 86.2% and a specificity of 77.3%, but even with such ad hoc adjustments the CSE fell marginally short of the required 80% for both specifications. Use of the CSE may enable clinicians to utilize existing resources more effectively by referring elderly people in need to appropriate medical care, accommodation and community support services, but further research is required to confirm the revised cutting scores for the CSE. Regression analysis showed that a combination of the raw LST score and the BDI score gained over 90% sensitivity and specificity, and such an actuarial approach also shows promise for future development.

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