**1.4. Early recognition of pathological cognitive decline by visuoconstructive and spatial tasks**

Assessment of cognitive impairments in the elderly is an important task of modern cognitive neuropsychology. Neuropsychological evaluation can respond to the expectations of valid and reliable differentiation of pathological from normal aging if it is accomplished by sufficiently sensitive, specific, and standardized psychometric tools [14]. The use of such tools is a requirement of the diagnostic algorithm for early discrimination of dementia from normal aging [9, 58]. The widely applied strategy to administer global clinical scales for screening and quantifying the level of individual cognitive deficit has low specificity, particularly in subjects with high or very low level of premorbid cognitive functioning and in the early stages of impairments in elderly [5, 14]. Short tests, assessing specific cognitive dysfunctions, are more accurate than the global cognitive scales [14, 59].

**2.** The influence of age on the visuoconstructive and visuospatial abilities in healthy elderly

Differentiating Normal Cognitive Aging from Cognitive Impairment No Dementia: A Focus…

http://dx.doi.org/10.5772/intechopen.73385

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**3.** The patterns of Benton Visual Retention Test (BVRT) performance in normal aging and in

The participants in this study were individuals over 60 years of age with normal daily functioning and without self-reported history of psychiatric and neurological disorders, residents of Plovdiv region*,* living independently in the community. The sample was divided in two groups: healthy subjects (MMSE ≥28), without cognitive complaints, and individuals with CIND (MMSE between 24 and 27 and subjective cognitive complains). The decision to accept the diagnostic category CIND was substantiated by the design of the study, which did not include the possibility of conducting detailed clinical, laboratory, and neuroimaging studies. After testing, all the participants from CIND group were advised to seek consultation from a general practitioner or neurologist to accurately identify the cause of the condition and the need for treatment. A total of 216 subjects were recruited for this study with the help of clubs for the elderly; 28 of them dropped out due to age below 60 years, impairments in every day functioning, visual disturbances that hindered neuropsychological testing, data from the interview about mild mental retardation, and test data for severe cognitive deficits. Only participants defining themselves as right handers were included in the study. Basic demographic characteristics of the study groups

**Age (years) Gender Education**

33%

43.5%

27.5%

36.4%

Mean SD max Male Female 1 2 3 **n % n %**

> 69 67%

48 56.5%

29 72.5%

14 63.6% 20 19.4%

33 38.8%

3 7.5%

5 22.7% 48 46.6%

33 38.8%

24 60.0%

10 45.5% 35 34.0%

19 22.3%

13 32.5%

7 31.8%

and individuals with CIND.

**2. Method and procedure**

**2.1. Subjects and recruitment**

are shown in **Table 1**.

**Healthy** 68.11 6.89 88 34

**CIND** 71.11 7.58 89 37

**Healthy** 67.00 5.19 78 11

**CIND** 70.36 6.86 83 8

Note: 1, primary and secondary school; 2, high school; and 3, college/university.

**Groups: Partial testing**

**Complete testing**

**Table 1.** Subject basic demographics.

CIND.

In order to detect age-related visual-spatial and constructive decline early enough, specific neuropsychological techniques are required. Such measures could be efficient and helpful if they take into account the age-related and pathological cognitive changes and assure accuracy of the assessment. Many different neuropsychological instruments are used to test the spatial functions [45]. The visuoconstructive ability is traditionally assessed by drawing of two- or three-dimensional figures [51, 52, 54] and block-building tasks [55] of varying complexity. Drawing neuropsychological tasks can detect the deficits in reproducing shapes, following their relationships in space, but it is difficult to standardize them [51], and in most cases, subject drawings are assessed "intuitively" and very rarely through an objective assessment system [52].

Drawing as a cognitive ability is not well studied in late-life adults. It is a complex multicomponent ability that engages perception, representation, memory, attention, spatial thinking, planning, and motor functions. Better knowledge of the structure of drawing process in old adults as well as of its age-related impairments can contribute to a more successful study of visual constructive and visual-spatial functions and their disturbances in old age.

Our study tests the hypothesis that short and easy-to-use visuoconstructive and visuospatial tests can be used to distinguish normal from pathological cognitive aging in its very early stages if appropriate, accurate, and valid criteria are applied. We use drawing of cube and drawing of house, together with other traditionally used and well-proven neuropsychological instruments—Benton Visual Retention Test (BVRT) and Block design—assessing visual memory, perception, constructional, and spatial abilities.

#### **1.5. Aims of the chapter**

The aims of this chapter are to explore the visuoconstructive and visuospatial abilities in normal and in pathological aging (CIND) above 60 years of age and to analyze:

**1.** The discriminative capacities of a set of visuoconstructive and visuospatial neuropsychological tasks in the differentiation of pathological (CIND) from normal cognitive aging over 60 years of age.

