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

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

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



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.


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


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.


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%.


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.


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

[Indexed for MEDLINE]

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