"Where did I park my car?" : a mixed methods investigation on mild cognitive impairment diagnosis in New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of a Doctor of Philosophy in Psychology at Massey University, Wellington, New Zealand. EMBARGOED until 11 May 2017
Mild cognitive impairment (MCI) is defined as an objective impairment in cognitive function which spares everyday functional ability. The syndrome is shrouded in controversy regarding definition, cut-off criteria, and clinical utility. Consequently, it is an uncertain label for the client being diagnosed by their healthcare practitioner. To date, minimal research in New Zealand has focused on MCI within specialist assessment services. Reasons for this paucity of literature will be discussed throughout this thesis. The current research aimed to identify how practitioners deliver and perceive cognitive impairment diagnosis, and examine how clients respond to receiving this diagnosis. Client experiences were framed within the common sense model (CSM). This theory originates from health psychology, where coping behaviour is said to be influenced by the cognitive representations that a person has about their condition. Although the framework is previously discussed in relation to chronic illness, international researchers have started to examine the utility of the model in explaining MCI diagnosis response. Given this context, the CSM framework guided the client-focused components of this thesis. In Study One, 57 practitioners who diagnose cognitive impairment completed a questionnaire on labels applied to MCI and beliefs about the value of diagnosis delivery. Responses were analysed using content analysis to gain an impression of professional practice. Cognitive disorder - not otherwise specified (CD-NOS), early dementia, and normal ageing were reported to additionally label the symptoms of MCI in clinical practice. In Study Two, client responses were examined in a small clinical sample (N = 9) diagnosed with MCI and CD-NOS. Participants were interviewed twice within six months of initial diagnosis. Interpretative phenomenological analysis was used to gain insight into how people cope and make sense of their diagnosis over time. Descriptive analyses were also undertaken with a subset of Study Two data to examine changes and differences in coping strategies over time. Findings suggest that participants may not see their diagnosis as an illness or significant health threat in the first six months following diagnosis. This prompts a question on the suitability of an illness model with reference to diagnosis response. Findings from this research add to the literature by highlighting practice associated with an evolving form of clinical diagnosis in NZ.