Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-01-12T22:47:27.377Z Has data issue: false hasContentIssue false

2 - Good Reasons for Non-standardization in the Administration of Cognitive Assessments

from Part 2 - Dementia and Diagnostics

Published online by Cambridge University Press:  21 November 2024

By
Danielle Jones ,
Clare Jackson  and
Ray Wilkinson
Edited by
Peter Muntigl ,
Charlotta Plejert  and
Danielle Jones
Peter Muntigl
Affiliation:
Universiteit Gent, Belgium
Charlotta Plejert
Affiliation:
Linköpings Universitet, Sweden
Danielle Jones
Affiliation:
University of Bradford
Get access

Summary

Chapter 2 delves into the intricate interactional dynamics of administering cognitive assessments, with a focus on the Addenbrooke’s Cognitive Examination-III (ACE-III). The chapter critically examines the standardisation challenges faced by clinicians in specialised memory assessment services, highlighting the nuanced reasons for non-standardized practices. While cognitive assessments play a pivotal role in diagnosing cognitive impairments, the study questions the assumed standardization of the testing process. Drawing on Conversation Analysis (CA), the authors analyse 40 video-recordings of the ACE-III being administered in clinical practice to reveal variations from standardized procedures. The chapter expands on earlier findings to show how clinicians employ recipient-design strategies during the assessment. It introduces new analyses of practitioner utterances in the third turn, suggesting deviations could be associated with practitioners’ working diagnoses. The chapter contends that non-standard administration is a nuanced response to the interactional and social challenges inherent in cognitive assessments. It argues that clinicians navigate a delicate balance between adhering to standardized procedures and tailoring interactions to individual patient needs, highlighting the complex interplay between clinical demands and recipient design. Ultimately, the chapter emphasizes the importance of understanding the social nature of cognitive assessments and provides insights into the valuable reasons for non-standardized practices in clinical settings.

Keywords

cognitive assessmentstandardizationAddenbrooke’s Cognitive Examination-IIIConversation Analysisdementiafunctional memory disorderrecipient-design
Type
Chapter
Information
Dementia and Language
The Lived Experience in Interaction
 , pp. 25 - 49
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alzheimer’s Society (2015) Helping you to assess cognition: A practical toolkit for clinicians. Available at: www.wamhinpc.org.uk/sites/default/files/dementia-practical-toolkit-for-clinicians.pdf.Google Scholar
Atkinson, M. and Drew, P. (1979) Order in Court: The Organization of Verbal Interaction in Judicial Settings. London: The Macmillan Press.CrossRefGoogle Scholar
Beach, W. A. (1993) ‘Transitional regularities for ‘casual’ “Okay” usages’. Journal of Pragmatics, 19: 325–352.CrossRefGoogle Scholar
Beishon, L. C., Batterham, A. P., Quinn, T. J., Nelson, C. P., Panerai, R. B., Robinson, T. and Haunton, V. J. (2019) ‘Addenbrooke’s Cognitive Examination III (ACE‑III) and mini‐ACE for the detection of dementia and mild cognitive impairment’. Cochrane Database of Systematic Reviews (12) CD013282. https://doi.org/10.1002/14651858.CD013282.pub2.CrossRefGoogle Scholar
Bolden, G. (2006) ‘Little words that matter: Discourse markers “so” and “oh” and the doing of other‐attentiveness in social interaction’. Journal of Communication, 56(4): 661–688.CrossRefGoogle Scholar
Bruno, D. and Schurmann Vignaga, S. (2019) ‘Addenbrooke’s cognitive examination III in the diagnosis of dementia: A critical review’. Neuropsychiatric Disease and Treatment, 15(15): 441–447.CrossRefGoogle ScholarPubMed
Button, G. (1987) ‘Answers as interactional products: Two sequential practices used in interviews’. Social Psychology Quarterly, 50(2): 160–171.CrossRefGoogle Scholar
Cahill, S. M., Gibb, M., Bruce, I., Headon, M. and Drury, M. (2008) ‘‘I was worried coming in because I don’t really know why it was arranged’: The subjective experience of new patients and their primary caregivers attending a memory clinic’. Dementia, 7(2): 175–189.CrossRefGoogle Scholar
Chandler, P. and Sweller, J. (1991) ‘Cognitive load theory and the format of instruction’. Cognition and Instruction, 8(4): 293–332.CrossRefGoogle Scholar
Cheston, R., Bender, M. and Byatt, S. (2000) ‘Involving people who have dementia in the evaluation of services: A review’. Journal of Mental Health, 9(5): 471–479.CrossRefGoogle Scholar
Clayman, S. E. (1988) ‘Displaying neutrality in television news interviews’. Social Problems, 35(4): 474–492.CrossRefGoogle Scholar
Clayman, S. E. and Heritage, J. (2002) The News Interview: Journalists and Public Figures on the Air. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Clayman, S. E., Heritage, J. and Hill, A. M. J. (2020) ‘Gender matters in questioning presidents’. Journal of Language and Politics, 19(1): 125–143.CrossRefGoogle Scholar
Crawford, S., Whitnall, L., Robertson, J. and Evans, J. J. (2012) ‘A systematic review of the accuracy and clinical utility of the Addenbrooke’s Cognitive Examination and the Addenbrooke’s Cognitive Examination-Revised in the diagnosis of dementia’. International Journal of Geriatric Psychiatry, 27: 659–669.CrossRefGoogle ScholarPubMed
Dooley, J., Bass, N. and McCabe, R. (2018) ‘How do doctors deliver a diagnosis of dementia in memory clinics?’ British Journal of Psychiatry, 212(4): 239–245.CrossRefGoogle ScholarPubMed
Drew, P., Raymond, G. and Weinberg, D. (eds.) (2006) Talking Research: Language and Interaction in Sociological Methodology. London: Sage.CrossRefGoogle Scholar
Elsey, C., Drew, P., Jones, D., Blackburn, D., Wakefield, S., Harkness, K. and Reuber, M. (2015) ‘Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics’. Patient Education and Counselling, 98(9): 1071–1077.CrossRefGoogle ScholarPubMed
Goffman, E. (1955) ‘On face-work’. Psychiatry, 18(3): 213–231.CrossRefGoogle ScholarPubMed
Goffman, E. (1967) Interaction Ritual: Essays on Face-to-Face Behavior. New York: Doubleday Anchor.Google Scholar
Heath, C. (1992) ‘The delivery and reception of diagnosis in the general-practice consultation’. In Drew, P. and Heritage, J. (eds.) Talk at Work: Interaction in Institutional Settings. Cambridge, UK: Cambridge University Press, pp. 235–267.Google Scholar
Hepburn, A. (2004) ‘Crying: Notes on description, transcription, and interaction’. Research on Language and Social Interaction, 37(3): 251–290.CrossRefGoogle Scholar
Heritage, J. (1998) ‘Oh-prefaced responses to inquiry’. Language in Society, 27: 291–334.CrossRefGoogle Scholar
Heritage, J. (2002) ‘Ad hoc inquiries: Two preferences in the design of routine questions in an open context’. In Maynard, D. W., Houtkoop-Steenstra, H., Schaeffer, N. C. and van der Zouwen, H. (eds.) Standardization and Tacit Knowledge Interaction and Practice in the Survey Interview. New York: Wiley, pp. 313–333.Google Scholar
Heritage, J. and Maynard, D. W. (2006) Communication in Medical Care. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Heritage, J. and Sorjonen, M. L. (1994) ‘Constituting and maintaining activities across sequences: And-prefacing as a feature of question design’. Language in Society, 23(1): 1–29.CrossRefGoogle Scholar
Heritage, J. and Stivers, T. (1999) ‘Online commentary in acute medical visits: A method of shaping patient expectations’. Social Science & Medicine, 49: 1501–1517.CrossRefGoogle ScholarPubMed
Heritage, J., Robinson, J., Elliott, M., Veckett, M. and Wilkes, M. (2007) ‘Reducing patients’ unmet concerns in primary care: The difference one word can make’. Journal of General Internal Medicine, 22: 1429–1433.CrossRefGoogle Scholar
Hoey, E. M. (2013) ‘Do sighs matter? Interactional perspectives on sighing’. Berkeley Linguistics Society 61–74, https://doi.org/10.3765/bls.v39i1.3870.CrossRefGoogle Scholar
Hoey, E. M. (2020) ‘Waiting to inhale: On sniffing in conversation’. Research on Language and Social Interaction, 53(1): 118–139.CrossRefGoogle Scholar
Houtkoop-Steenstra, H. (1995) ‘Meeting both ends: Between standardization and recipient design in telephone survey interviews’. In Ten Have, P. and Psathas, G. (eds.) Situated Order: Studies in the Social Organization of Talk and Embodied Activities. Washington, DC: University Press of America pp. 91–107.Google Scholar
Houtkoop-Steenstra, H. (1997) ‘Being friendly in survey interviews’. Journal of Pragmatics, 28: 591–623.CrossRefGoogle Scholar
Houtkoop-Steenstra, H. (2000) Interaction and the Standardized Survey Interview. The Living Questionnaire. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Houtkoop-Steenstra, H. and Antaki, C. (1997) ‘Creating happy people by asking yes-no questions’. Research on Language and Social Interaction, 30(4): 285–313.CrossRefGoogle Scholar
Hsieh, S., Schubert, S., Hoon, C., Mioshi, E. and Hodges, J. R. (2013) ‘Validation of the Addenbrooke’s Cognitive Examination III in frontotemporal dementia and Alzheimer’s disease’. Dementia and Geriatric Cognitive Disorders, 36(3–4): 242–250.CrossRefGoogle ScholarPubMed
Jones, D., Drew, P., Elsey, C., Blackburn, D., Wakefield, S., Harkness, K. and Reuber, M. (2016) ‘Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders’. Aging & Mental Health, 20(5): 500–509.CrossRefGoogle ScholarPubMed
Jones, D., Wilkinson, R., Jackson, C. and Drew, P. (2020) ‘Variation and interactional non-standardization in neuropsychological tests: The case of the Addenbrooke’s Cognitive Examination’. Qualitative Health Research, 30(3): 458–470.CrossRefGoogle ScholarPubMed
Koole, T. (2010) ‘Displays of epistemic access: Student responses to teacher explanations’. Research on Language and Social Interaction, 43(2): 183–209.CrossRefGoogle Scholar
Leydon, G. M. and Barnes, R. K. (2020) ‘Conversation Analysis’. In Pope, C. and Mays, N. (4 ed.) Qualitative Research in Health Care. Hoboken, NJ: Wiley Publications, pp. 135–150.CrossRefGoogle Scholar
Lindeberg, S., Samuelsson, C. and Müller, N. (2019) ‘Swedish clinical professionals’ perspectives on evaluating cognitive and communicative function in dementia’. Clinical Gerontologist, 1–15, https://doi.org/10.1080/07317115.2019.1701168.CrossRefGoogle Scholar
Majlesi, A. R. and Plejert, C. (2018) ‘Embodiment in tests of cognitive functioning: A study of an interpreter-mediated dementia evaluation’. Dementia, 17(2): 138–163.CrossRefGoogle ScholarPubMed
Marlaire, C. and Maynard, D. W. (1990) ‘Standardized testing as an interactional phenomenon’. Sociology of Education, 63: 83–101.CrossRefGoogle Scholar
Maynard, D. W. (2017) ‘Delivering bad news in emergency care medicine’. Acute Medicine & Surgery, 4(1): 3–11.CrossRefGoogle ScholarPubMed
Maynard, D. W. and Marlaire, C. L. (1992) ‘Good reasons for bad testing performance: The interactional substrate of educational exams’. Qualitative Sociology, 15(2): 177–202.CrossRefGoogle Scholar
Maynard, D. and Schaeffer, N. C. (2006) ‘Standardization-in-interaction: The survey interview’. In Drew, P.., Raymond, G.. and Weinberg, D. (eds.) Talking Research: Language and Interaction in Sociological Methodology. London: Sage, pp. 9–27.CrossRefGoogle Scholar
Maynard, D. W. and Turowetz, J. (2017) ‘Doing testing: How concrete competence can facilitate or inhibit performances of children with autism spectrum disorder’. Qualitative Sociology, 40: 467–491.CrossRefGoogle Scholar
Maynard, D. W., Houtkoop-Steenstra, H., Schaeffer, N. C. and van der Zouwen, H. (2002) Standardization and Tacit Knowledge Interaction and Practice in the Survey Interview. New York: Wiley.Google Scholar
McHoul, A. (1978) ‘The organization of turns at formal talk in the classroom’. Language in Society, 7: 183–213.CrossRefGoogle Scholar
Mehan, H., Hertweck, A. and Meihls, J. L. (1986) Handicapping the Handicapped: Decision-Making in Students’ Educational Careers. Stanford, CA: Stanford University Press.CrossRefGoogle Scholar
Merritt, M. (1980) ‘On the use of “OK” in service encounters’. In Shuy, R. W. and Shnukal, A. (eds.) Language Use and the Uses of Language. Washington, DC: Georgetown University Press, pp. 162–172.Google Scholar
Nielsen, T. R., Segers, K., Vanderaspoilden, V., Beinhoff, U., Minthon, L., Pissiota, A., Bekkhus-Wetterberg, P., Bjørkløf, G. H., Tsolaki, M., Gkioka, M. and Waldemar, G. (2019) ‘Validation of a brief Multicultural Cognitive Examination (MCE) for evaluation of dementia’. International Journal of Geriatric Psychiatry, 34(7): 982–989.CrossRefGoogle ScholarPubMed
Panegyres, P. K., Berry, R. and Burchell, J. (2016) ‘Early dementia screening’. Diagnostics, 6(1): 6.CrossRefGoogle ScholarPubMed
Pennington, C., Newson, M., Hayre, M. and Coulthard, E. (2015) ‘Functional cognitive disorder: What is it and what to do about it?’ Practical Neurology, 15(6): 436–444CrossRefGoogle Scholar
Peräkylä, A. (1998) ‘Authority and accountability: The delivery of diagnosis in primary health care’. Social Psychology Quarterly, 61: 301–320.CrossRefGoogle Scholar
Pond, C. D., Mate, K. E., Phillips, J., Stocks, N. P., Magin, P. J., Weaver, N. and Brodaty, H. (2013) ‘Predictors of agreement between general practitioner detection of dementia and the revised Cambridge Cognitive Assessment (CAMCOG‑R)’. International Psychogeriatrics, 25(10): 1639–1647, https://doi.org/10.1017/S1041610213000884.CrossRefGoogle ScholarPubMed
Raymond, G. (2003) ‘Grammar and social organization: Yes/no interrogatives and the structure of responding’. American Sociological Review, 68(6): 939–967.CrossRefGoogle Scholar
Reuber, M., Blackburn, D., Elsey, C., Wakefield, S., Ardern, K., Harkness, K., Venneri, A., Jones, D., Shaw, C. and Drew, P. (2018) ‘An interactional profile to assist the differential diagnosis of neurodegenerative and functional memory disorders’. Alzheimer Disease & Associated Disorders: An International Journal, 32(3): 197–206.CrossRefGoogle ScholarPubMed
Reuber, M., Monzoni, C., Sharrack, B. and Plug, L. (2009) ‘Using interactional and linguistic analysis to distinguish between epileptic and psychogenic nonepileptic seizures: A prospective, blinded multirater study’. Epilepsy & Behavior, 16: 139–144.CrossRefGoogle ScholarPubMed
Right Decisions Service (2017) ACE-III and M-ACE English Guide 2017. Available https://rightdecisions.scot.nhs.uk/media/vk2cizbp/ace-iii-scoring-guide-uk-2017.pdf.Google Scholar
Robinson, J. D. and Heritage, J. (2014) ‘Intervening with conversation analysis: The case of medicine’. Research on Language and Social Interaction, 47(3): 201–218.CrossRefGoogle Scholar
Sacks, H. (1992) Lectures on Conversation (Vol. II, Jefferson, G., ed.). Oxford: Blackwell.Google Scholar
Schegloff, E. A. (1972) ‘Notes on a conversational practice: Formulating place’. In Sudnow, D. (ed.) Studies in Social Interaction. New York: The Free Press, pp. 75–119.Google Scholar
Schegloff, E. A. (1992) ‘Repair after next turn: The last structurally provided defense of intersubjectivity in conversation’. American Journal of Sociology, 97(5): 1295–1345.CrossRefGoogle Scholar
Schegloff, E. A. (2007) Sequence Organization in Interaction: A Primer in Conversation Analysis, Volume 1. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Stevanovic, M. and Peräkylä, A. (2012) ‘Deontic rights in interaction: The right to announce, propose, and decide’. Research on Language & Social Interaction, 45(3): 297–321.CrossRefGoogle Scholar
Stivers, T. (2002) ‘Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric encounters’. Social Science & Medicine, 54: 1111–1130.CrossRefGoogle ScholarPubMed
Stivers, T. (2007) Prescribing under Pressure: Parent-Physician Conversations and Antibiotics. London: Oxford University Press.CrossRefGoogle Scholar
Stivers, T. and Barnes, R. (2018) ‘Treatment recommendation actions, contingencies, and responses: An introduction’. Health Communication, 33(11): 1331–1334, https://doi.org/10.1080/10410236.2017.1350914.CrossRefGoogle ScholarPubMed
Swallow, J. and Hillman, A. (2018) ‘Fear and anxiety: Affects, emotions and care practices in the memory clinic’. Social Studies of Science, https://doi.org/10.1177/0306312718820965.CrossRefGoogle Scholar
Toerien, M. (2021) ‘When do patients exercise their right to refuse treatment? A conversation analytic study of decision-making trajectories in UK neurology outpatient consultations’. Social Science and Medicine, 290: 114278, https://doi.org/10.1016/j.socscimed.2021.114278.CrossRefGoogle ScholarPubMed
Venneri, A. (2005) ‘The promised land: The blooming business of neurosychological assessment guidance books’. Cortex, 41: 96–98.CrossRefGoogle Scholar
Wilkinson, R. (2013) ‘The interactional organization of aphasia naming testing’. Clinical Linguistics and Phonetics, 27(10–11): 805–822.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×