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The Hunt for Cognitive Impairment Screening Tests

By Jen A. Miller

steven moelterWhen STEPHEN T. MOELTER, PhD, director of the USciences undergraduate program in psychology and associate professor of psychology, looks at cognitive impairment in connection to a brain disease, he asks two questions: First, what is the quality of the evidence that suggests the brain is impaired? Second, if the evidence is sound, what are the best instruments to show how much the brain is compromised?

Through his research, he looks for improved ways to determine which patients have brain impairment so they can get the help or medicine they need sooner rather than later.

In a five-year program funded by the Pennsylvania Department of Health, Dr. Moelter and colleagues from the University of Pennsylvania studied how to diagnose Alzheimer’s disease (AD) earlier. “We wanted to know what cognitive differences we could observe very early in the disease,” he said. While Alzheimer’s disease can’t be reversed, patients who are identified as having the disease early will likely have the best chance to improve as diseasemodifying medicines become available.

Through their research, Dr. Moelter and his colleagues tested a simple screening test that was an accurate predictor of a patient’s Clinical Dementia Rating (CDR), which is a gold standard for determining functional impairment but one that requires a lengthy interview that must be administered by a clinician. Instead, the shortened screen is highly predictive of CDR score and could be done by a family member in less than five minutes.

moelter quoteDr. Moelter and his colleagues from UPenn also tested cognitive screening instruments in Parkinson’s patients, many of whom suffer from some form of cognitive impairment because of the disease. In a study funded by the National Institute of Neurological Disorders and Stroke, and recently published in the journal Neurology, the research team compared a brief cognitive test to other measures that determine whether a Parkinson’s patient was capable of understanding the research consent process independently or whether the patient suffered from cognitive impairment to a level that he or she should have help in making decisions.

The team assessed the patients’ cognitive level on the Montreal Cognitive Assessment (MoCA)—a common screening instrument. The result was that the MoCA is “highly predictive of whether the expert would judge a patient capable or not,” said Dr. Moelter.

Dr. Moelter and his collegues from George Mason University and UPenn are studying older adults with both sleep apnea and mild cognitive impairment (MCI), a clinical condition that represents, for some patients, the early stages of Alzheimer’s disease. “In sleep apnea, patients have periodic episodes where they stop breathing, which means oxygen is not getting to the brain,” said Dr. Moelter. “It’s a double whammy. Theoretically, this could increase the odds that sleep apnea patients who already have MCI progress toward Alzheimer’s.”

In the study, which is funded by the National Institute on Aging, Dr. Moelter and his colleagues are performing a clinical trial to understand if people who adhere to continuous positive airway pressure (CPAP) treatment for their sleep apnea, which is designed to stop those periods of nonbreathing, are less likely to progress toward AD. The research team expects that those
who adhere to CPAP will show less of a decline on cognitive tests and in brain structures associated with AD.

The research conducted by Dr. Moelter and his team was published by the American Academy of Neurology in Neurology (2013; 81(9):801–807). It was also the subject of an editorial in that same issue complimenting the work.

Read more about the exciting research conducted at USciences.

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