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  • Review Article
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Neuropsychological assessment of patients with dementing illness

Nature Reviews Neurology volume 7, pages 677–687 (2011)Cite this article

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Abstract

Neuropsychological assessment has a distinct role in the detection and monitoring of cognitive and functional changes associated with dementing illness. Molecular, structural and functional neuroimaging studies have advanced our understanding of the anatomy and physiology underlying neurodegenerative disease; however, the overlap in pathological features of different dementia-associated diseases limits the information that can be obtained by these methods. Incorporation of information obtained from multiple sources can help to increase diagnostic and prognostic accuracy. Neuropsychological test findings provide unique value as biomarkers of dementia, as differentiators of disease topography and in the estimation of disease risk and trajectory. However, psychometric test properties—such as construct validity, stability and the use of appropriate norms—must be understood, because they influence both the application of neuropsychological tests and the interpretation of their results. Finally, measurement of cognitive strengths and weaknesses in patients at risk of dementia can be helpful to predict changes in functional abilities, design appropriate and effective interventions, and assist family and health-care providers in the planning of the patient's future care needs. This Review describes the key characteristics of neuropsychological testing in the assessment of patients at risk of dementia.

Key Points

  • Neuropsychological parameters serve as biomarkers for and potent predictors of the development of dementia

  • Serial use of neuropsychological tests can dynamically capture the effects of various influences on disease trajectory

  • Deficits on neuropsychological measures are proxies for functional deficiencies in patients with possible dementia

  • Neuropsychological test results can be used to identify targets for intervention; for example, intact procedural memory might be used to compensate for deficient declarative memory

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Figure 1: Dynamic changes in biomarkers associated with the progression of Alzheimer disease, and dementia with Lewy bodies.
Figure 2: Ages at onset of the cardinal features of dementia with Lewy bodies.
Figure 3: Cognitive domains underlying commonly used neuropsychological measures.
Figure 4: Representative neuropsychological profiles for patients with different autopsy-confirmed forms of dementia.
Figure 5: Interaction of age, family history and memory performance in predicting 5-year risk of cognitive impairment.
Figure 6: Hypothetical model of dementia prevention.

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Acknowledgements

This work was supported by NIH grants 1K12HD065987, RO1 AG15866, P50 AG16574 and R01 NR12419. We wish to acknowledge our colleagues affiliated with the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program of the Mayo Foundation.

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Authors and Affiliations

  1. Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, 55905, MN, USA

    Julie A. Fields & Glenn E. Smith

  2. Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, 55905, MN, USA

    Bradley F. Boeve

  3. Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 4500 San Pablo Road, Jacksonville, 32224, FL, USA

    Tanis J. Ferman

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  1. Julie A. Fields
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  2. Tanis J. Ferman
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  3. Bradley F. Boeve
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  4. Glenn E. Smith
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Contributions

J. A. Fields researched data for the article. G. E. Smith and J. A. Fields organized and wrote the article. T. J. Ferman and B. F. Boeve contributed to discussions of the content and to review and/or editing of the manuscript before submission.

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Correspondence to Glenn E. Smith.

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The authors declare no competing financial interests.

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Fields, J., Ferman, T., Boeve, B. et al. Neuropsychological assessment of patients with dementing illness. Nat Rev Neurol 7, 677–687 (2011). https://doi.org/10.1038/nrneurol.2011.173

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