Dementia Evaluation
Introduction
The purpose of this review is to evaluate three assessment batteries used for the evaluation of neurocognitive disorders; specifically, dementia and aphasia. According to Murray and Clarke (2014), dementia is defined as “a chronic, progressive deterioration of memory and at least one other area, such as personality, communication ability, or executive control functioning.” In contrast, Murray and Clarke define aphasia as “a disruption in using and understanding language following a neurological injury or disease that is not related to general intellectual decline or sensorimotor deficits.”
The assessment tools that will be evaluated in this review, due to their relation to the aforementioned disorders, include: The Functional …show more content…
Linguistic Communication Inventory (FLCI; Bayles & Tomodea, 1994), The Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN; Millman & Holland, 2012), and The Minnesota Test for Differential Diagnosis of Aphasia (MTDDA; Schuell, 1965). The following sections will review each test individually and then compare each across several domains.
Evaluation of Assessments
FLCI
The need for a test that determined the cognitive and linguistic abilities of people with Alzheimer's Disease (AD) was noted by authors Bayle and Tomodea (1994); they created the FLCI to meet this need. They also noted that time is an exceptionally important component in assessment, especially when working with individuals with AD. Many Speech-Language Pathologists will treat and evaluate these individuals in skilled nursing and rehabilitation centers, where caseloads are full and time is limited; therefore, Bayle and Tomodea found distinct importance to provide a test that could be administered in no more than 30 minutes. This timing also benefits the clients, as many adults with cognitive issues, such as dementia, may demonstrate difficulty with completing lengthier tests. The FLCI comes with an easy-to-read manual detailing how to administer the exam, and the individual administering the test requires no additional training in order to administer the exam.
The FLCI has sub-sections that examine the following: greeting and naming, answering questions, writings, sign comprehension, object-to-picture matching, word reading and comprehension, following commands, and pantomime, gesture and conversational abilities, determining a client's baseline level of function, the severity of the patient's dementia, and the client's preserved functional skills, making comparisons of examinee's performance to performance profiles of other patients at different levels of severity.
SCCAN
The SCCAN is a norm-referenced assessment battery normed on populations age 18 to 95. This assessment tool is utilized for individuals with cognitive and communication deficits, such as aphasia, dementia or other undiagnosed disorders. The SCCAN can also be used to identify individuals with deficits in neurocognition and communication and classify the severity. Furthermore, for individuals who require therapy, the SCCAN can help determine an appropriate treatment plan and helps to determine changes related to improvement and decline, made over time.
The SCCAN consists of eight scales that are functional for the daily living of individuals in the normed population, these areas include: oral expression, orientation, memory, speech comprehension, reading comprehension, writing, attention, and problem-solving (Carl, Gallo & Johnson, 2014). Papathanasiou and Coppens (2016) noted that the SCCAN is effective in comparison to other assessment batteries as the subtests not only evaluate the spoken and written language abilities of individuals, but also the cognitive abilities related to attention, executive function, and memory, and behavioral observations such as eye contact, verbosity, response time, reduced initiation, and several other qualities.
The questions within the SCCAN are functional for daily living, such as referencing the number of pills that should be taken every morning, referencing menus when ordering, and dialing an emergency number on a telephone. This is important, as it helps the Speech-Language Pathologist establish whether the client could independently complete these activities.
MTDDA
The MTDDA is the most comprehensive test to measure a patient's strengths and weaknesses in all language modalities. The MTDDA provides a differential diagnosis to determine whether a patient has aphasia or if they have aphasia with additional disorders. This test does not differentiate between the different types of aphasia. It consists of 46 subtests divided into 5 sections: auditory disturbances, visual and reading disturbances, speech and language disturbances, visuomotor and writing disturbances, and disturbances of numerical relations and arithmetic processes. The MTDDA also helps to guide in planning treatment for the individual based on the scores obtained and can provide a prediction of the patient’s recovery. In terms of planning treatment, the MTDDA provides an assortment of task and item comparisons so the clinician can make a decision about the basic problems to be treated in future treatment sessions.
Compare and Contrast
FLCI and SCCAN
Comparatively, there are a few similarities between both the FLCI and the SCCAN.
Both tests are short and take an average of 30 minutes to administer. This could be important, as many tests for AD, dementia, aphasia, or traumatic brain injury are administered in outpatient care centers where a Speech-Language Pathologist may not have a wealth of time to complete testing. Another similarity is that neither test requires the administrator to have additional training or certification to give the examination.
In relation to the contents of each test, the FLCI and SCCAN can both be used to test the client’s functional skills that contribute to their daily living. Test items are designed to be functional for the examinee. Finally, both tests have were created with an older adult population in mind and have large print and graphics to increase the ease of administration.
There are also several notable differences between the FLCI and the SCCAN. The SCCAN aims to test individuals with probable aphasia, dementia, or other undiagnosed disorders. In contrast, the FLCI is only utilized to test individuals with Alzheimer's. Although both sample populations include individuals with Alzheimer’s Disease, the SCCAN incorporates more individuals with Alzheimer's and more diversity of the …show more content…
disorder.
In relation to the contents of the test, the FLCI tests pragmatic abilities in addition to comprehension and cognition. The SCCAN, in contrast, looks more at nonverbal behavioral abilities. The FLCI further consists of tests regarding following directions across several modalities, including commands, pantomime, and gestures. The SCCAN does not directly test these areas.
SCCAN and Minnesota
The SCCAN and the MTDDA are geared towards testing individuals with probable aphasia. Both the SCCAN and the Minnesota help in determining a plan of treatment for the patient exhibiting deficits in cognition and communication. Both the SCCAN and the MTDDA include questions that relate to the patient’s mathematical abilities; however, the actual questions used in the SCAAN are much more functional than those used in the MTDDA, including real life scenarios such as ordering and paying for a meal at a restaurant Neither the SCCAN nor the MTDDA require the administrator to have additional certification or training.
As previously noted, the SCCAN is convenient for Speech-Language Pathologists in all settings, as it is quickly administered and generally takes 30 minutes to administer. In contrast, the Minnesota takes an average of three hours to administer and may not be realistic to complete in some settings, such as the hospital. In addition, the SCCAN’s directions are concise and easily executed, while the MTDDA’s directions may be up to interpretation by the client and the administrator, leading to variation.
In relation to the contents of the test, the SCCAN and MTDDA differ greatly. One example is the picture quality. The SCCAN consists of colored pictures that are functional for clients. In contrast, the Minnesota provides images that are black and white and may be difficult to differentiate between. Within subtests, the MTDDA examines nonlinguistic abilities of the client; whereas the SCAAN exclusively tests the client’s linguistic abilities.
Minnesota and FLCI
While the similarities between the FLCI and the MTDDA may not be readily apparent, there are similarities present.
Both the FLCI and the MTDDA are standardized assessment tools. Both the FLCI and the MTDDA help in planning the treatment following the assessment. Both the FLCI and the MTDDA have a subtest that measures the client’s writing skills. The FLCI and the MTDDA can both be utilized to establish baselines for treatment. Due to the length to administer the MTDDA, it would most likely only be used as an initial assessment, while the FLCI could be used later on.
Upon examination of the Minnesota and the FLCI, differences have been noted in terms of the population of interest, administration of the test, and subtest measurements. The Minnesota has been out of print since the early 2000’s. Due to this, individuals seeking the Minnesota must go to the publisher. This is important because the Minnesota could still theoretically be used; however, the materials might be out of date in comparison to other tests. The FLCI, in contrast, is currently commercially available; therefore, it will more likely be updated and
functional.
For populations of interest, the Minnesota tests for aphasia, and aphasia with co-occurring disorders such as visual involvement or sensorimotor involvement; whereas, the FLCI tests for Alzheimer’s Disease only. It terms of test administration, The MTDDA takes approximately 3 hours to administer to a patient, while the FLCI only take an average of 30 minutes to administer. The MTDDA includes a subtest to measure the patient’s arithmetic ability and numerical processing skills, whereas no subtest exists to measure mathematical and numerical skills in the FLCI. In addition, the FLCI directly tests conversational abilities, which can be important in individuals with aphasia, although it is not normed on this population. The MTDDA does not formally consider these areas.
Conclusion
It is critical for Speech Language Pathologists to have knowledge and understanding of the assessment batteries readily available to them. It is equally important that they possess and understanding of the populations to be used with each test, and the type and quality of information gained from administering a particular test. This paper provides a basic overview and comparison of the following tests: The Functional Linguistic Communication Inventory (FLCI), The Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN), and The Minnesota Test for Differential Diagnosis of Aphasia (MTDDA).
These tests assess diverse populations, including dementia, language/cognitive disorders, multiple disorders with unestablished diagnosis, and aphasia. When selecting an assessment battery, it is important to understand the normed-population in comparison to client concern.
The purpose of this review is to evaluate three assessment batteries used for the evaluation of neurocognitive disorders; specifically, dementia and aphasia. According to Murray and Clarke (2014), dementia is defined as “a chronic, progressive deterioration of memory and at least one other area, such as personality, communication ability, or executive control functioning.” In contrast, Murray and Clarke define aphasia as “a disruption in using and understanding language following a neurological injury or disease that is not related to general intellectual decline or sensorimotor deficits.”
The assessment tools that will be evaluated in this review, due to their relation to the aforementioned disorders, include: The Functional …show more content…
Linguistic Communication Inventory (FLCI; Bayles & Tomodea, 1994), The Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN; Millman & Holland, 2012), and The Minnesota Test for Differential Diagnosis of Aphasia (MTDDA; Schuell, 1965). The following sections will review each test individually and then compare each across several domains.
Evaluation of Assessments
FLCI
The need for a test that determined the cognitive and linguistic abilities of people with Alzheimer's Disease (AD) was noted by authors Bayle and Tomodea (1994); they created the FLCI to meet this need. They also noted that time is an exceptionally important component in assessment, especially when working with individuals with AD. Many Speech-Language Pathologists will treat and evaluate these individuals in skilled nursing and rehabilitation centers, where caseloads are full and time is limited; therefore, Bayle and Tomodea found distinct importance to provide a test that could be administered in no more than 30 minutes. This timing also benefits the clients, as many adults with cognitive issues, such as dementia, may demonstrate difficulty with completing lengthier tests. The FLCI comes with an easy-to-read manual detailing how to administer the exam, and the individual administering the test requires no additional training in order to administer the exam.
The FLCI has sub-sections that examine the following: greeting and naming, answering questions, writings, sign comprehension, object-to-picture matching, word reading and comprehension, following commands, and pantomime, gesture and conversational abilities, determining a client's baseline level of function, the severity of the patient's dementia, and the client's preserved functional skills, making comparisons of examinee's performance to performance profiles of other patients at different levels of severity.
SCCAN
The SCCAN is a norm-referenced assessment battery normed on populations age 18 to 95. This assessment tool is utilized for individuals with cognitive and communication deficits, such as aphasia, dementia or other undiagnosed disorders. The SCCAN can also be used to identify individuals with deficits in neurocognition and communication and classify the severity. Furthermore, for individuals who require therapy, the SCCAN can help determine an appropriate treatment plan and helps to determine changes related to improvement and decline, made over time.
The SCCAN consists of eight scales that are functional for the daily living of individuals in the normed population, these areas include: oral expression, orientation, memory, speech comprehension, reading comprehension, writing, attention, and problem-solving (Carl, Gallo & Johnson, 2014). Papathanasiou and Coppens (2016) noted that the SCCAN is effective in comparison to other assessment batteries as the subtests not only evaluate the spoken and written language abilities of individuals, but also the cognitive abilities related to attention, executive function, and memory, and behavioral observations such as eye contact, verbosity, response time, reduced initiation, and several other qualities.
The questions within the SCCAN are functional for daily living, such as referencing the number of pills that should be taken every morning, referencing menus when ordering, and dialing an emergency number on a telephone. This is important, as it helps the Speech-Language Pathologist establish whether the client could independently complete these activities.
MTDDA
The MTDDA is the most comprehensive test to measure a patient's strengths and weaknesses in all language modalities. The MTDDA provides a differential diagnosis to determine whether a patient has aphasia or if they have aphasia with additional disorders. This test does not differentiate between the different types of aphasia. It consists of 46 subtests divided into 5 sections: auditory disturbances, visual and reading disturbances, speech and language disturbances, visuomotor and writing disturbances, and disturbances of numerical relations and arithmetic processes. The MTDDA also helps to guide in planning treatment for the individual based on the scores obtained and can provide a prediction of the patient’s recovery. In terms of planning treatment, the MTDDA provides an assortment of task and item comparisons so the clinician can make a decision about the basic problems to be treated in future treatment sessions.
Compare and Contrast
FLCI and SCCAN
Comparatively, there are a few similarities between both the FLCI and the SCCAN.
Both tests are short and take an average of 30 minutes to administer. This could be important, as many tests for AD, dementia, aphasia, or traumatic brain injury are administered in outpatient care centers where a Speech-Language Pathologist may not have a wealth of time to complete testing. Another similarity is that neither test requires the administrator to have additional training or certification to give the examination.
In relation to the contents of each test, the FLCI and SCCAN can both be used to test the client’s functional skills that contribute to their daily living. Test items are designed to be functional for the examinee. Finally, both tests have were created with an older adult population in mind and have large print and graphics to increase the ease of administration.
There are also several notable differences between the FLCI and the SCCAN. The SCCAN aims to test individuals with probable aphasia, dementia, or other undiagnosed disorders. In contrast, the FLCI is only utilized to test individuals with Alzheimer's. Although both sample populations include individuals with Alzheimer’s Disease, the SCCAN incorporates more individuals with Alzheimer's and more diversity of the …show more content…
disorder.
In relation to the contents of the test, the FLCI tests pragmatic abilities in addition to comprehension and cognition. The SCCAN, in contrast, looks more at nonverbal behavioral abilities. The FLCI further consists of tests regarding following directions across several modalities, including commands, pantomime, and gestures. The SCCAN does not directly test these areas.
SCCAN and Minnesota
The SCCAN and the MTDDA are geared towards testing individuals with probable aphasia. Both the SCCAN and the Minnesota help in determining a plan of treatment for the patient exhibiting deficits in cognition and communication. Both the SCCAN and the MTDDA include questions that relate to the patient’s mathematical abilities; however, the actual questions used in the SCAAN are much more functional than those used in the MTDDA, including real life scenarios such as ordering and paying for a meal at a restaurant Neither the SCCAN nor the MTDDA require the administrator to have additional certification or training.
As previously noted, the SCCAN is convenient for Speech-Language Pathologists in all settings, as it is quickly administered and generally takes 30 minutes to administer. In contrast, the Minnesota takes an average of three hours to administer and may not be realistic to complete in some settings, such as the hospital. In addition, the SCCAN’s directions are concise and easily executed, while the MTDDA’s directions may be up to interpretation by the client and the administrator, leading to variation.
In relation to the contents of the test, the SCCAN and MTDDA differ greatly. One example is the picture quality. The SCCAN consists of colored pictures that are functional for clients. In contrast, the Minnesota provides images that are black and white and may be difficult to differentiate between. Within subtests, the MTDDA examines nonlinguistic abilities of the client; whereas the SCAAN exclusively tests the client’s linguistic abilities.
Minnesota and FLCI
While the similarities between the FLCI and the MTDDA may not be readily apparent, there are similarities present.
Both the FLCI and the MTDDA are standardized assessment tools. Both the FLCI and the MTDDA help in planning the treatment following the assessment. Both the FLCI and the MTDDA have a subtest that measures the client’s writing skills. The FLCI and the MTDDA can both be utilized to establish baselines for treatment. Due to the length to administer the MTDDA, it would most likely only be used as an initial assessment, while the FLCI could be used later on.
Upon examination of the Minnesota and the FLCI, differences have been noted in terms of the population of interest, administration of the test, and subtest measurements. The Minnesota has been out of print since the early 2000’s. Due to this, individuals seeking the Minnesota must go to the publisher. This is important because the Minnesota could still theoretically be used; however, the materials might be out of date in comparison to other tests. The FLCI, in contrast, is currently commercially available; therefore, it will more likely be updated and
functional.
For populations of interest, the Minnesota tests for aphasia, and aphasia with co-occurring disorders such as visual involvement or sensorimotor involvement; whereas, the FLCI tests for Alzheimer’s Disease only. It terms of test administration, The MTDDA takes approximately 3 hours to administer to a patient, while the FLCI only take an average of 30 minutes to administer. The MTDDA includes a subtest to measure the patient’s arithmetic ability and numerical processing skills, whereas no subtest exists to measure mathematical and numerical skills in the FLCI. In addition, the FLCI directly tests conversational abilities, which can be important in individuals with aphasia, although it is not normed on this population. The MTDDA does not formally consider these areas.
Conclusion
It is critical for Speech Language Pathologists to have knowledge and understanding of the assessment batteries readily available to them. It is equally important that they possess and understanding of the populations to be used with each test, and the type and quality of information gained from administering a particular test. This paper provides a basic overview and comparison of the following tests: The Functional Linguistic Communication Inventory (FLCI), The Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN), and The Minnesota Test for Differential Diagnosis of Aphasia (MTDDA).
These tests assess diverse populations, including dementia, language/cognitive disorders, multiple disorders with unestablished diagnosis, and aphasia. When selecting an assessment battery, it is important to understand the normed-population in comparison to client concern.