Page 42 - Handbook of Electronic Assistive Technology

Chapter 2 • Cognitive Impairment and EAT 29

Of the 39 tests identified, the Addenbrookes Cognitive Examination (ACE-R, Mioshi
et al., 2006) covers key cognitive, psychiatric and functional abilities and its latest version
(ACE-III, Noone, 2015) has been widely used in a variety of settings to date. The Oxford
Cognitive Screen (Demeyere et al., 2015) was designed for use with stroke patients; how-
ever, it has the advantage of being suitable for administration to those with aphasia and
neglect, and it returns a visual snapshot of a person’s cognitive profile, which can be use-
ful in identifying potential barriers to the use of EAT. Further work is clearly needed to
validate and evaluate the value of different screening tools in the context of technology
prescription.

Developmental, Acquired and Progressive Cognitive
Impairment

Diagnosis of cognitive impairment is not straightforward. Practitioners and researchers
acknowledge the limitations in both the current scientific knowledge and in the diagnostic
tools available to them (Berk, 2013; Carlew and Zartman, 2016; Ruff, 2003). A number of
features are widely recognised and differentiated, as they adequately reflect clinical presen-
tation, have some value in aiding prognosis, and map into the aetiology of the impairment.
The International Classification of Diseases (ICD) and the Diagnostic and Statistical
Manual for Mental Disorders (DSM) are key references in the field of psychology. Their
conceptualisation of disorders with known biological aetiology has evolved over time, with
an increasing focus on empirical knowledge (Carlew and Zartman, 2016). Both manuals
distinguish cognitive impairment that occurs early in life, changes over the course of the
lifespan and persists into adulthood (neurodevelopmental disorders), from cognitive
decline that arises suddenly (acquired) or gradually (progressive) in adulthood (neurocog-
nitive disorders).
This general distinction is informative because the characteristics and course of the
cognitive and functional abilities differ across the three categories of disorders: develop-
mental, acquired and progressive. Neurodevelopmental disorders are characterised by
persistence of symptoms into adulthood, but also by changes in symptoms over the course
of the lifespan (Carlew and Zartman, 2016). In contrast, the diagnosis of neurocognitive
disorder requires the presence of decline from a previous level of performance (Simpson,
2014). In acquired disorders (e.g., cognitive deterioration associated with traumatic brain
injury), this decline may not be permanent, or it may be amenable to treatment and reha-
bilitation (Berlucchi, 2011; Robertson and Murre, 1999). In progressive disorders (e.g.,
dementia of Alzheimer’s type), the initial cognitive decline is likely to aggravate over time,
and the range of impaired functions likely to broaden.
These differences typically have implications for various steps of the process of pre-
scribing assistive technology (Stack et al., 2009), in particular its usage, including instal-
lation, personalisation, length and intensity of training of the end-user and of their
supporting environment. It may also influence other aspects of the process and its