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

Article type: Research Article

Authors: Jansen, Willemijn J.^{a; *} | Handels, Ron L.H.^a | Visser, Pieter Jelle^{a; b} | Aalten, Pauline^a | Bouwman, Femke^b | Claassen, Jurgen^c | van Domburg, Peter^d | Hoff, Erik^e | Hoogmoed, Jan^{f; g} | Leentjens, Albert F.G.^a | Rikkert, Marcel Olde^c | Oleksik, Ania M.^h | Smid, Machielⁱ | Scheltens, Philip^b | Wolfs, Claire^a | Verhey, Frans^a | Ramakers, Inez H.G.B.^a

Affiliations: [a] Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands | [b] Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands | [c] Department of Geriatrics, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands | [d] Department of Neurology, Zuyderland Medical Center, Sittard, The Netherlands | [e] Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands | [f] Department of Geriatrics, Laurentius Hospital, Roermond, The Netherlands | [g] Department of Geriatrics, St. Jans Gasthuis, Weert, The Netherlands | [h] Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands | [i] Department of Geriatrics, Zuyderland Medical Center, Sittard, The Netherlands

Correspondence: [*] Correspondence to: Willemijn J. Jansen, Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 43 3884089; Fax: +31 43 3884092; E-mail: willemijn.jansen@maastrichtuniversity.nl.

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, prognosis, mild cognitive impairment, neuropsychological tests, outpatient clinic, reclassification

DOI: 10.3233/JAD-160126

Journal: Journal of Alzheimer's Disease, vol. 55, no. 2, pp. 679-689, 2017