METHODOLOGICAL ISSUES IN COGNITIVE ASSESSMENT AND THEIR IMPACT ON OUTCOME MEASUREMENT

Assessment of cognitive impairment in chronic care populations is comp licated by several factors that may interfere with the assessment proc ess: physical frailty and disability; comorbid conditions such as depr ession; and decrements in vision, hearing, speech, and general communi cation. Moreover, cognitive impairment itself affects assessment of ou tcome domains such as depression, behavior, and function, thus contrib uting to several sources of measurement bias. Sources of bias are disc ussed in the context of findings from the literature relating individu al and cognitive factors to outcome measurement. Recommendations for f urther methodological research are provided.