In individuals with suspected or confirmed brain disorders, cognitive screening via performance-based tests conveys pivotal information both towards diagnosis and prognosis and within interventional settings. Moreover, such tests are often employed as outcomes measures within clinical studies addressing cognition. Hence, cognitive screeners need to come with sound statistical and feasibility features. However, within the Italian scenario, cognitive screeners do not always present with such characteristics. Moreover, remote cognitive screening procedures have been historically underdeveloped in Italy, despite easily lending themselves to be delivered from a distance via practicable media, such as the telephone. However, by bridging down geographical, logistical, socio-demographic and economic barriers, the availability of telephone-based cognitive screeners would both entail improvements in healthcare settings and ease the implementation and accomplishment of clinical studies. Given the above premises, within the first two Sections of the present Dissertation, after outlining the principles underlying screening procedures in general, a comprehensive, practical framework for the statistical study of cognitive screeners is delivered – addressing 1) their applications for population-screening and case-findings aims within both clinical practice and research, as well as the issues of 2) clinimetrics (i.e., psychometrics and diagnostics), 3) norm derivation (with a focus on the Equivalent Score method) and 4) cross-sectional/longitudinal feasibility. In addition, Section 2 delivers an extensive, critical discussion on the 1) rationale, 2) benefits and shortcomings and 3) clinical/research applications of telephone-based cognitive screeners – also focusing on 4) the statistical issues related to their standardization. Within the third Section, after providing an up-to-date synopsis of the Italian status quo as to the statistical features of both in-person and telephone-based cognitive screeners, a number of recently published investigations are summarized that focused on updating norms and/or improving the clinimetrics and feasibility of three Italian, in-person cognitive screeners – i.e., 1) the Frontal Assessment Battery (FAB), 2) the Montreal Cognitive Assessment (MoCA) and 3) the cognitive section of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Subsequently, Section 3 displays the description of recently published, Italian standardization studies of telephone-based cognitive screeners – i.e., 1) the Telephone Interview for Cognitive Status (TICS), 2) the ALS Cognitive Behavioural Screen-Phone Version (ALS-CBS-PhV) and 3) the telephone-based Frontal Assessment Battery (t-FAB). Then, Section 4 reports in full two currently unpublished studies – the first, addressing the assessment of the clinical usability of the Italian TICS, the second, providing the Italian standardization of a telephone-based screener for language disorders, i.e. the Telephone Language Screener (TLS). A synoptic glance at the content of the present Dissertation, the future perspectives yielding from it and a number of critical considerations related to outstanding issues on the topic of cognitive screening in Italy are finally delivered within the conclusive, fifth Section.
In individui con disturbi cerebrali sospetti o confermati, lo screening cognitivo tramite test performance-based convoglia informazioni di rilievo sia in termini diagnostici e prognostici che in ambito interventistico. Inoltre, tali test vengono spesso impiegati come misure di outcome nell’ambito di studi clinici aventi come oggetto la cognizione. Pertanto, gli screener cognitivi devono possedere solide caratteristiche statistiche e di usabilità. Tuttavia, nel panorama Italiano, gli screener cognitivi non sempre possiedono tali caratteristiche. Inoltre, in Italia, le pratiche di screening cognitivo da remoto sono state storicamente poco considerate, nonostante si prestino facilmente ad essere erogate a distanza tramite media di facile impiego, come il telefono. Tuttavia, avendo il potenziale di abbattere barriere geografiche, logistiche, socio-demografiche ed economiche, la disponibilità di screener cognitivi telefonici implicherebbe rilevanti vantaggi sia in ambito clinico che per l’implementazione e la portata a termine di studi clinici. In ragione di quanto suddetto, nelle prime due Sezioni della presente Dissertazione, in seguito ad una panoramica generale dei principi sottesi alle procedure di screening, viene fornita un’esauriente cornice per lo studio statistico degli screener cognitivi – affrontando 1) le loro applicazioni a fini di screening di popolazione e di case-finding nella pratica e ricerca cliniche, nonché le questioni relative a 2) proprietà clinimetriche (i.e., caratteristiche psicometriche e diagnostiche), 3) taratura (con un focus sul metodo dei Punteggi Equivalenti) e 4) usabilità trasversale/longitudinale. Inoltre, la Sezione 2 riporta una discussione dettagliata e critica 1) sul razionale, 2) su vantaggi e svantaggi e 3) sulle applicazioni cliniche/di ricerca degli screener cognitivi telefonici – focalizzandosi anche 4) sugli aspetti statistici relativi alla loro standardizzazione. Nella terza Sezione, in seguito ad una sinossi aggiornata in merito allo status quo Italiano relativo alle caratteristiche statistiche degli screener di persona e telefonici, viene riassunta una serie di studi recentemente pubblicati e focalizzantesi sull’aggiornamento della taratura e/o sul miglioramento delle proprietà clinimetriche e dell’usabilità di tre screener Italiani di persona – i.e., 1) la Frontal Assessment Battery (FAB), 2) il Montreal Cognitive Assessment (MoCA) e 3) la sezione cognitiva dell’Edinburgh Cognitive and Behavioural ALS Screen (ECAS). In seguito, la Sezione 3 include la descrizione di alcuni studi di standardizzazione Italian di screener telefonici – i.e., la Telephone Interview for Cognitive Status (TICS), 2) l’ALS Cognitive Behavioural Screen-Phone Version (ALS-CBS-PhV) e 3) la telephone-based Frontal Assessment Battery (t-FAB). Successivamente, la Sezione 4 riporta per intero due studi al momento non ancora pubblicati – il primo, relativo alla valutazione dell’usabilità clinica della TICS Italiana, il secondo, riportante la standardizzazione di uno screening telefonico per i disturbi linguistici, i.e. il Telephone Language Screener (TLS). Infine, la quinta e conclusiva Sezione riporta uno sguardo sinottico al contenuto della presente Dissertazione, le prospettive future derivanti da essa e una serie di considerazioni critiche in merito alle questioni aperte sul tema dello screening cognitivo in Italia.
(2023). Cognitive screening in Italy: study framework and recent advances. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2023).
Cognitive screening in Italy: study framework and recent advances
AIELLO, EDOARDO NICOLÒ
2023
Abstract
In individuals with suspected or confirmed brain disorders, cognitive screening via performance-based tests conveys pivotal information both towards diagnosis and prognosis and within interventional settings. Moreover, such tests are often employed as outcomes measures within clinical studies addressing cognition. Hence, cognitive screeners need to come with sound statistical and feasibility features. However, within the Italian scenario, cognitive screeners do not always present with such characteristics. Moreover, remote cognitive screening procedures have been historically underdeveloped in Italy, despite easily lending themselves to be delivered from a distance via practicable media, such as the telephone. However, by bridging down geographical, logistical, socio-demographic and economic barriers, the availability of telephone-based cognitive screeners would both entail improvements in healthcare settings and ease the implementation and accomplishment of clinical studies. Given the above premises, within the first two Sections of the present Dissertation, after outlining the principles underlying screening procedures in general, a comprehensive, practical framework for the statistical study of cognitive screeners is delivered – addressing 1) their applications for population-screening and case-findings aims within both clinical practice and research, as well as the issues of 2) clinimetrics (i.e., psychometrics and diagnostics), 3) norm derivation (with a focus on the Equivalent Score method) and 4) cross-sectional/longitudinal feasibility. In addition, Section 2 delivers an extensive, critical discussion on the 1) rationale, 2) benefits and shortcomings and 3) clinical/research applications of telephone-based cognitive screeners – also focusing on 4) the statistical issues related to their standardization. Within the third Section, after providing an up-to-date synopsis of the Italian status quo as to the statistical features of both in-person and telephone-based cognitive screeners, a number of recently published investigations are summarized that focused on updating norms and/or improving the clinimetrics and feasibility of three Italian, in-person cognitive screeners – i.e., 1) the Frontal Assessment Battery (FAB), 2) the Montreal Cognitive Assessment (MoCA) and 3) the cognitive section of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Subsequently, Section 3 displays the description of recently published, Italian standardization studies of telephone-based cognitive screeners – i.e., 1) the Telephone Interview for Cognitive Status (TICS), 2) the ALS Cognitive Behavioural Screen-Phone Version (ALS-CBS-PhV) and 3) the telephone-based Frontal Assessment Battery (t-FAB). Then, Section 4 reports in full two currently unpublished studies – the first, addressing the assessment of the clinical usability of the Italian TICS, the second, providing the Italian standardization of a telephone-based screener for language disorders, i.e. the Telephone Language Screener (TLS). A synoptic glance at the content of the present Dissertation, the future perspectives yielding from it and a number of critical considerations related to outstanding issues on the topic of cognitive screening in Italy are finally delivered within the conclusive, fifth Section.File | Dimensione | Formato | |
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Descrizione: Tesi di Aiello Edoardo Nicolò - 788980
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