Dissertations, Theses, and Capstone Projects

Date of Degree

9-2024

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Laura Rabin

Committee Members

Desiree Byrd

Justin Storbeck

Kathleen Mangiapanello

Anjali Krishnan

Subject Categories

Clinical Psychology | Cognitive Science | Geropsychology

Keywords

Cross-cultural neuropsychology, diversity issues, mild cognitive impairment, subjective cognitive concerns, aging

Abstract

Mild cognitive impairment (MCI) is thought to represent an intermediate stage of cognitive impairment that is often, but not always, a transitional phase between normal aging and dementia. Diagnostic criteria for “MCI” and international consensus criteria have been developed and refined over decades beginning in the 1990s, but the definition is still debated. Moreover, the operationalization and measurement of one of the criteria for MCI (i.e., subjective cognitive concerns, SCC), which is included in most classification approaches, is highly variable and there is great inconsistency across the literature. Some research efforts even support the removal of this criterion on the basis that it does not meaningfully contribute to diagnosis or may lead to misdiagnosis of MCI. Indeed, some individuals with MCI, especially in the later stages, demonstrate poor awareness of cognitive decline—rendering the inclusion of SCC for defining MCI open to debate. Current definitions and criteria for MCI were developed in largely homogenous populations of non-Hispanic White and highly educated individuals with college degrees. It is unclear which MCI definition approach offers the greatest diagnostic and prognostic accuracy, particularly for racially and ethnically diverse older adults. Thus far, only one study compared diagnostic agreement and predictive validity of MCI definitions in diverse older adults, with a moderate sample comprised of participants within a specialized memory clinic (who tend to be more impaired than older adults from the community). These multiple issues and gaps in research prompted us to: (1) compare the predictive validity for incident dementia of four MCI definitions; and (2) investigate various operational definitions of both self- and informant concerns about cognition to determine whether their inclusion in two widely used definitions of MCI add to the predictive validity for incident dementia. It is hoped that these efforts will help to identify the optimal standardized approach to diagnosing MCI in diverse community-dwelling older adult samples.

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