The Diagnostic and Prognostic Value of Neuropsychological Assessment in Memory Clinic Patients.
J Alzheimers Dis
; 55(2): 679-689, 2017.
Article
em En
| MEDLINE
| ID: mdl-27716658
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% (nâ=â14) correctly reclassified, etiology: net reclassification improvement [NRI]â=â0.61, prognosis: NRIâ=â0.13) or MCI (syndrome: 89.3% (nâ=â23) correctly reclassified, etiology: NRIâ=â0.17, prognosis: NRIâ=â0.14), while there was no improvement in patients with dementia (syndrome: 100% (nâ=â1) correctly reclassified, etiology: NRIâ=â-0.05, prognosis: NRIâ=â-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.
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01-internacional
Base de dados:
MEDLINE
Assunto principal:
Transtornos da Memória
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Testes Neuropsicológicos
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
Idioma:
En
Revista:
J Alzheimers Dis
Ano de publicação:
2017
Tipo de documento:
Article