Computerized methods for cognitive assessment of the elderly: Options and limitations

The aging of the population carries grave social and economic implications. Older people are susceptible to diseases, and their financial income is frequendy restricted. Tied together with the reduced birth rate, this century is likely to witness marked changes. The health of older people will be affected by both physical and mental problems. Among those, dementia will have a major role. Not surprisingly, marked attempts are directed in attempt to better understand the biology of dementia and to find cures. The physical changes in the brain resulting in cognitive decline are the results of multiple mechanisms, where both primary neurodegenerative processes and vascular changes exert their toll. The main underlying process is thought to be Alzheimer's disease, although in most cases mixed dementia occurs, i.e. more than a single process contributes. Several methods to identify biological markers are being actively developed, using imaging biochemistry, etc. However, the methods so far developed are expensive and time consuming, and are unlikely to be available to the large number of cases needed. Moreover, they are always directed at a given disease process, e.g. Alzheimer disease or vascular brain disease. Another popular method - neuropsychological examination - also has its limitations, being expensive, long and demanding an expert to administer. A method is therefore needed which will enable the identification of cognitive decline at a very early stage. Computerized cognitive assessment can be used for the initial screening phase of the process of cognitive evaluation, before other methods of evaluation would be employed. However, computerized cognitive testing is still far from wide usage in the healthcare markets. In this chapter is we shall discuss the reasons for tills poor penetration of computerizebd methods for cognitive assessment, and suggest some solutions.