TY - JOUR
T1 - The Diagnostic and Prognostic Value of Neuropsychological Assessment in Memory Clinic Patients
AU - Jansen, Willemijn J.
AU - Handels, Ron L.H.
AU - Visser, Pieter Jelle
AU - Aalten, Pauline
AU - Bouwman, Femke
AU - Claassen, Jurgen
AU - Van Domburg, Peter
AU - Hoff, Erik
AU - Hoogmoed, Jan
AU - Leentjens, Albert F.G.
AU - Rikkert, Marcel Olde
AU - Oleksik, Ania M.
AU - Smid, Machiel
AU - Scheltens, Philip
AU - Wolfs, Claire
AU - Verhey, Frans
AU - Ramakers, Inez H.G.B.
PY - 2017
Y1 - 2017
N2 - 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.
AB - 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.
KW - Alzheimer's disease
KW - cognitive disorders
KW - consensus
KW - diagnosis
KW - mild cognitive impairment
KW - neuropsychological tests
KW - outpatient clinic
KW - prognosis
KW - reclassification
UR - http://www.scopus.com/inward/record.url?scp=84999143634&partnerID=8YFLogxK
U2 - 10.3233/JAD-160126
DO - 10.3233/JAD-160126
M3 - Article
C2 - 27716658
AN - SCOPUS:84999143634
VL - 55
SP - 679
EP - 689
JO - Journal of Alzheimer's Disease
JF - Journal of Alzheimer's Disease
SN - 1387-2877
IS - 2
ER -