Last updated on November 12th, 2024 at 09:40 am
Can a 10 minute test diagnose and differentiate AZ from Frontal Lobe dementia?
Email: dr.les.ruthven@gmail.com
Health Blog: www.ruthvenassessments.com
The Ruthven Impairment Assessment (RIA) is a 15 minute, online, computer performance measure of the full range of cognitive impairment. The RIA was created and developed by this retired clinical psychologist who specialized in clinical and research neuropsychology (The RIA appeared in a normative study of 55 college students tested 3 times in a 10 day period which was published in Applied Neuropsychology in March of 2017.) There are little or no practice effects observed in serial testing, no gender performance differences on any of the 5 subtests and only a slight decrement of memory on subjects ranging in age from 17 to 58 years. The RIA is performed with the space bar and mouse on the right half of the computer screen, which consists of a standard 12 numbered clock face on the right with task instructions on the left half of the screen. In addition to the test the site includes an optional health history and 10 item behavior and symptom check list.
The first three tasks are simple, complex and conditional Reaction times (RT). Subject Instructions on subtest 1 is to press the space bar as quickly as one can to any lighted clock number, press the space bar on task 2 to any lighted odd number, and on task 3 to bar press to any number following two even lighted numbers except if that following number is a 6 or a 10 (these 2 numbers change on each administration of the test). It was found that RTs on tasks 2 and 3 in cognitively normal persons are 50% slower than simple RT but not when there is reversible and irreversible brain impairment. In Ci persons task 3 is more difficult than task 2 due to the complexity of the instructions of task 3 vs. task 2. Subjects with structural brain damage have greater difficulty on task 3 vs. those with Reversible brain impairment. If RT on tasks 2 and 3 are greater than One Standard Deviation slower than subtest 1 the relationship is diagnostic of either reversible or irreversible static or progressive brain damage depending on the test profile as a whole. The writer believes RIA impairment data suggests that both neurology and neuropsychology have an exclusive concern with structural brain damage since their diagnostic tools do not address the many cases of cognitive impairment without causing actual and permanent brain damage. The writer believes, however, that some causes of reversible brain impairment (e.g. some medicines)–for example many psychiatric drugs–cause irreversible brain impairment when the individual is chronically exposed to these and other causes.
Here are some RIA scores from a previously bright 84 year old female with a Ph.D. On the 3 RT tests the subject has i.5 seconds to respond. The subject in question had 7 of 1o items correct (i.e., within 1.5 sec.) on subtest 1, 10 correct on subtest 2, and only 4 correct within the time limit on subtest 3. Cognitively normal subjects handle the greater complexity of subtest 3 instructions without difficulty but not so those with moderate to severe brain impairment. On subtest 4 (attention/memory) the subject had a score of 5 out of 8, which indicates moderate memory impairment. It is rare for a cognitively normal person not to get the maximum score of 8. Subtest 5 is the most intellectually and cognitively demanding test of the 5 subtests. Subtest 5, unlike the others, has 13 rather than 9 items. The first 3 items are very easy and more explanatory than diagnostic in nature. In subtest 5 there are several series of 5 lighted clock numbers, the S is to look for a theme or pattern in the numbers and to left click with the mouse two numbers that would continue or end the theme. For example, if a series is presented of 1,2,3,4,and 5 the S would left click on the numbers of 6 and 7 to end the series. Our subject being discussed had only 3 items correct, most likely the explanatory items, which suggests pronounced impairment of higher level abstraction/ executive functions. The greater impairment of executive over memory abilities would point to a progressive frontal lobe dementia rather than Az. If the reader would like to have a copy of the above subject’ test scores, and the test norms on 55 college students, make this request at the above email.
A note on interpreting RIA profiles: Any psychological test, including the RIA, is both a science and an art. Correct interpretation requires the psychologist to have a good grasp of the research and clinical findings on the RIA plus a good deal of experience in testing both cognitively normal individuals and those with various forms of clinical pathology. In addition to the test itself the RIA includes a health history of the person (including medications) and a 10 item questionnaire on symptoms and behavior. The RIA is a powerful brain impairing screening test but it was developed to perform as the initial and not the final diagnostic tool.
Psychologists who may be interested in evaluating the RIA for their research or clinical practice are invited to receive access to the RIA without charge at the present time.
