Academic journal article New Zealand Journal of Psychology

Diagnostic Processes and Disclosure: A Survey of Practitioners Diagnosing Cognitive Impairment

Academic journal article New Zealand Journal of Psychology

Diagnostic Processes and Disclosure: A Survey of Practitioners Diagnosing Cognitive Impairment

Article excerpt

The rapid ageing of the population in the Western world (de Meijer, Wouterse, Polder, & Koopmanschap, 2013) is associated with increased rates of age-related pathology such as dementia (Alzheimers New Zealand, 2010; Ministry of Health, 2013). The development of effective healthcare policies to meet the future needs of this age group poses a considerable challenge (Naaldenberg, Vaadrager, Koelen, & Leeuwis, 2011). In consideration of the upward trend observed in national epidemiology reports (Statistics New Zealand, 2000), the need for research focusing on older adult healthcare in New Zealand (NZ) is essential.

The issue of declining memory ability is an area that has received increased attention in academic literature to date. Dementia is defined as a group of symptoms which affect memory and cognitive ability, as well as everyday functional ability (Ihl et al., 2011). Although dementia related pathology is not a normal part of the ageing process (Nelson et al., 2011), often an association is drawn between declining cognition and the realities of older age (Schneider & Yvon, 2013). For this reason, a diagnosis of dementia has been linked with stigma and fear (Aminzadeh, Byszewski, Molnar, & Eisner, 2007; Phillipson, Magee, Jones, & Skladzien, 2012). As the numbers of those diagnosed with dementia increases (Portacolone, Berridge, Johnson, & Schicktanz, 2014), the news of such a diagnosis has become significantly more feared than any other age-related health condition (Batsch & Mittelman, 2012). These reactions are fuelled not only by the emotional impact of a dementia diagnosis (Aminzadeh et al., 2007; Nicholson, 2013) but also pragmatic implications, such as loss of independence (e g., revoked drivers license; Byszewski et al., 2013).

Mild cognitive impairment (MCI) is a related concept in the dementia field which is fraught with contention, both in academic literature and diagnostic practice. MCI is defined as a condition whereby a decline in ability is observed across one or more cognitive domains, although everyday functional ability remains intact (Albert et al., 2011). As a term, MCI was originally used by Reisburg and associates in the 1980s but later defined as a diagnostic entity by Peterson et al. (1999). There has been an ongoing debate since regarding the definition and diagnostic utility of MCI, which shows no sign of remittance some 20 years later (see Peterson et al., 2014). The release of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013) has arguably added to the controversy, with terms such as dementia and mild cognitive impairment replaced with major and mild neurocognitive disorder (NCD; Breitner, 2014). Mild NCD is identified as a form of cognitive disorder which may or may not progress to dementia (Sachs-Ericsson & Blazer, 2014). Despite these dissensions and changes in terminology, the presence of MCI as a clinical entity has remained a relatively stable prognostic indicator for an increased risk of a dementia pathology over time (Breitner, 2014). Due to the evolving nature of MCI (Gordon & Martin, 2013; Peterson et al., 2014) and the lack of peer reviewed literature in NZ relating to diagnostic issues around cognitive impairment, the present study will use the term "cognitive impairment" to refer to a diagnosis of dementia and MCI.

In NZ, specialist service professionals such as geriatricians, clinical psychologists, and neuropsychologists are often responsible for providing healthcare service users with a diagnosis of dementia (Ministry of Health, 2013). The process by which a diagnosis is reached and delivered can be variable according to the unique needs and circumstances of the client, available resources for testing, and preferred assessment measures in District Health Board (DHB) regions. In addition to these differences in assessment practices, international literature reports varying levels of depth regarding the disclosure of a dementia diagnosis by practitioners (Bamford et al. …

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