Lecture 11: Assessment Flashcards
Importance of neuropsychological assessment (Smith & Bondi, 2013)
- Roles in dementia assessment and care:
- serve as biomarker
- predictor for development of dementia
- capture different influences disease trajectory
- proxies for functional deficits
- insight into intervention targets
Assessment
- Biomarker for illness
- Biomarker – characteristic that is objectively measured as indicator of a biological process, normal or pathological
- so that also includes neuropsychological testing
- Neuropsychological profile - distinguish underlying pathologies
- Different brain areas affect
- Different neuropsychological profiles
Hutchinson & Mathias (2007) – meta-analysis 94 studies comparing FTD and AD
- Best discrimination FTD and AD:
Hutchinson & Mathias (2007) – meta-analysis 94 studies comparing FTD and AD
Best discrimination FTD and AD:
- Memory tests: FTD better than AD
- Language/verbal ability tests: FTD poorer than AD
204 bvFTD, 674 AD, 126 age-matched HC (Ranasinghe et al., 2016)
- differentiating bvFTD and AD
204 bvFTD, 674 AD, 126 age-matched HC (Ranasinghe et al., 2016)
- Memory: AD < bvFTD < HC
- Language: naming, lexical fluency bvFTD < AD
Biomarker for illness
- Ferman et al (2006) – DLB vs. AD
- Meta-analysis neuropsychological differences DLB and AD (Gurnani & Gavett, 2017) – 14 studies included autopsy confirmed DLB (n=155) or AD (n=431
Ferman et al (2006) – DLB vs. AD
- lower scores AVLT and BNT - diagnosis DLB less likely
- lower scores TMT-A and RCFT – diagnosis DLB more likely
Meta-analysis neuropsychological differences DLB and AD (Gurnani & Gavett, 2017) – 14 studies included autopsy confirmed DLB (n=155) or AD (n=431
- AD memory worse
- DLB visuospatial worse
Biomarker for illness
- Reed et al. (2007) autopsy diagnosis confirmed VaD or AD
- Meta-analysis (Mathias & Burke, 2009): VaD v. AD
Reed et al. (2007) autopsy diagnosis confirmed VaD or AD
- AD: memory poorer than EF
- CVD/VaD: EF poorer than memory
Meta-analysis (Mathias & Burke, 2009)
Assessment
- Predictor development of dementia
- Poorer cognition could represent increased risk years before diagnosis
- episodic memory scores lower at least 6 years before diagnosis AD (Bäckman et al., 2001)
- aMCI, naMCI (as a risk factor for Dementia)
Assessment
- Capture different influences on disease trajectory
- ¨Severity of disease plus other factors that influence performance, e.g. compensation, cognitive reserve
- Cognitive functioning only partially explained by extent neuropathology
Assessment
- Proxies for functional deficits
- functional deficit – what person can or can no longer do in daily life (e.g. wash, dress, shop, drive)
- matters most to person and their family
- Neuropsychological measures help estimate functional outcomes
- difficult with neuroimaging/other biomarkers
Assessment
- Insights intervention targets
- Neuropsychological measures can identify residual strengths/spared functions
- Possible target interventions
- Compensating for impairments using spared functions
- e.g. relatively spared procedural memory
- learning habit using calendar (Greenaway et al., 2008)
- e.g. relatively spared procedural memory
Assessment
- To make valuable contribution
To make valuable contribution
- neuropsychological tests of sufficient quality
- validity and sensitivity
- not screening tools only
- e.g. MMSE
- multiple measures to assess particular domain
- e.g. memory, EF
Assessment
- To make valuable contribution
- Tuokko & Smart:
To make valuable contribution
- Tuokko & Smart: test results interpreted in biopsychosocial framework
- Many factors contribute to current functioning:
- e.g early life experiences, prior functioning, ocupation, current physical health, sensory functioning
- Many factors contribute to current functioning:
Assessment
- Differential diagnosis: dementia - depression
- Depression-related cognitive impairment (similar like in dementia)
- Objective impairments or complaints in both disorders
- demtia is rsk factor for depression and depression is risk factor for dementia
- depression: emphasize disability, even though objective deficits mild
- negative mood not reported (stigma of depression)
- report physical symptoms (e.g. fatigue) or cognitive complaints
- negative mood not reported (stigma of depression)
- Treatment and expected time course different
- depression curable; dementia not
Depression and dementia
- Depression common in various forms dementia
- (Zhao et al., 2016)
Depression common in various forms dementia
- AD, VaD, DLB, MCI
- Starkstein et al. (2005): 670 probable AD – 50% symptoms depression
- Ballard et al. (2013): depression possibly more common DLB than AD
Depression symptom dementia
¨Presence depression risk factor dementia
¨Presence depression risk factor dementia
- MCI + depression more likely convert dementia than MCI without depression
- Depression increased likelihood cognitive impairments 9 year follow-up (Rosenberg et al., 2010)
Picture: score of memory test, immediate and late recall, over time. More depressive symptom s: sharper cognitive decline
Distinguish dementia from depression
- pseudodementia” or “reversible dementia”
¨pseudodementia” or “reversible dementia”
- suggests dichotomy - either dementia or depression
- both may be present
- suggests symptoms completely reversible
- often not the case
*
Differential diagnosis depression - dementia
- Onset cognitive symptoms:
- Subjective complaints (type of)
Onset cognitive symptoms
- Depression – acute (days or weeks)
- Dementia – gradual (years)
Subjective complaints (type of)
- Depression - complaints about cognitive impairments
- may be more severe than daily functioning suggests
- Dementia – lack of insight common, minimize cognitive impairments
Differential diagnosis depression - dementia
- NPS
NPS (Neuropsychiatric symptom)
- Apathy (diminished initiative, lack interest) without dysphoria more common in dementia
- Dysphoria (sadness, guilt, self-criticism) more common depression
Differential diagnosis depression - dementia
- Neuropsychological profile
Neuropsychological profile
- Cognitive impairments more severe in dementia (AD) than in depression
- Impairments progressive in dementia
- Impairments stable or improve in depression
Differential diagnosis depression - dementia
- Neuropsychological profile
- Memory and EF
¨Neuropsychological profile
- Memory most prominent impairment AD
- EF more prominent impairment depression
- Memory tasks: depression benefit cueing
- depression – improvement on recognition, no improvement in AD
Summary differential features depression and AD:
- key criteria for dementia is that it shall not be caused by another disorder (e.g. a stroke or a tumor or a psychiatric disorder)
- in depression that is not an exclusion criteria
Assessment
- assessment tools
- Interview
- Neuropsychological tests
- Neuroimaging
Assessment
- Interview
Interview
- subjective complaints, e.g.
- memory
- hallucinations
- language
- apathy
- changes personality
- prior functioning
- onset
- course of progression
- abrupt or gradual
- current functioning: independence
- medical and psychiatric history – impact physical health
- social situation
Assessment
- Neuropsychological tests
Neuropsychological tests
- objective measures
- support subjective complaints?
-
neuropsychological profile:
- various domains, including:
- memory ………?
- subprocesses, e.g.
- learning, delayed recall, recognition
- semantic memory, episodic memory
- various domains, including:
Assessment
- Neuroimaging
Neuroimaging
- Confirm/exclude diagnosis based on interview and tests:
- Atrophy medial temporal
- Atrophy frontal anterior temporal
- Infarcts/CVD
- PET amyloid imaging
- tumor
