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J Alzheimers Dis. 2017;55(2):679-689.

The Diagnostic and Prognostic Value of Neuropsychological Assessment in Memory Clinic Patients.

Author information

1
Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
2
Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
3
Department of Geriatrics, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
4
Department of Neurology, Zuyderland Medical Center, Sittard, The Netherlands.
5
Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands.
6
Department of Geriatrics, Laurentius Hospital, Roermond, The Netherlands.
7
Department of Geriatrics, St. Jans Gasthuis, Weert, The Netherlands.
8
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
9
Department of Geriatrics, Zuyderland Medical Center, Sittard, The Netherlands.

Abstract

BACKGROUND:

Neuropsychological testing has long been embedded in daily clinical practice at memory clinics but the added value of a complete neuropsychological assessment (NPA) to standard clinical evaluation is unknown.

OBJECTIVE:

To evaluate the added diagnostic and prognostic value of NPA to clinical evaluation only in memory clinic patients.

METHODS:

In 221 memory clinic patients of a prospective cohort study, clinical experts diagnosed clinical syndrome (subjective cognitive impairment (SCI), mild cognitive impairment (MCI), or dementia) and etiology (Alzheimer's disease (AD) or no AD), and provided a prognosis of disease course (decline or no decline) before and after results of NPA were made available. The reference standard was a panel consensus based on all clinical information at baseline and up to 2 follow-up assessments.

RESULTS:

With NPA data available, clinicians changed their initial syndromal diagnosis in 22% of patients, and the etiological diagnosis as well as the prognosis in 15%. This led to an increase in correctly classified cases of 18% for syndromal diagnosis, 5% for etiological diagnosis, and 1% for prognosis. NPA data resulted in the largest improvement in patients initially classified as SCI (syndrome: 93.3% (n = 14) correctly reclassified, etiology: net reclassification improvement [NRI] = 0.61, prognosis: NRI = 0.13) or MCI (syndrome: 89.3% (n = 23) correctly reclassified, etiology: NRI = 0.17, prognosis: NRI = 0.14), while there was no improvement in patients with dementia (syndrome: 100% (n = 1) correctly reclassified, etiology: NRI = -0.05, prognosis: NRI = -0.06). Overall, inclusion of NPA in the diagnostic process increased confidence in all diagnoses with 6-7%.

CONCLUSION:

Administration of a complete NPA after standard clinical evaluation has added value for diagnosing cognitive syndrome and its underlying etiology in patients regarded as non-demented based on the first clinical impression.

KEYWORDS:

Alzheimer’s disease; cognitive disorders; consensus; diagnosis; mild cognitive impairment; neuropsychological tests; outpatient clinic; prognosis; reclassification

PMID:
27716658
DOI:
10.3233/JAD-160126
[Indexed for MEDLINE]

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