Dementia: Update for the Practitioner

Neuropsychology of Mild Cognitive Impairment, Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia
Penne Sims, Ph.D.

What Is Assessed

Neuropsychological testing is used to assess a number of cognitive domains in diagnosing, screening, and following patients with mild cognitive impairment, Alzheimer's disease, frontotemporal lobe dementia, and Lewy-body dementia, among other brain disorders. The first of these cognitive domains is premorbid intellectual functioning, prior the onset of any brain dysfunction, which is evaluated from several pieces of information: level of education, level of occupational functioning, and certain cognitive skills that can be relatively resistant to aging effects, such as vocabulary or basic reading of words. We also look at current intellectual functioning: how the individual processes, classifies, and integrates information. The level of functioning on those skills gives us an idea of where that patient or individual should be, given no symptomatology.


	Cognitive Functions Assessed by Neuropsychological Evaluation premorbid intellectual functioning intellectual functioning attention/concentration memory functioning language functioning executive functioning visual perception motor functioning personality functioning

	Neuropsychological testing is used to assess a number of domains in diagnosing, screening, and following patients with dementia. Courtesy of Penne Sims, Ph.D.

There are a number of tests used in making this assessment. You may be familiar with the Wechsler tests; there have been several revisions of those, one of which is an abbreviated version that gives you an estimated level of IQ rather than the full IQ assessment that we would obtain from the full tests. An average IQ is 90 to 109. We also look at attention, predominantly sustained attention, by looking at the ability to subtract serial sevens or to recite a list of numbers in reverse order.


	IQ Ranges
	130 and above 120–129 110–119 90–109 80–89 70–79 69 and below		very superior superior high average average low average borderline defective

	Ranges of IQ scores as used in neuropsychological testing. Courtesy of Penne Sims, Ph.D.

To evaluate memory, we look at several specific aspects: verbal memory and visual memory, then immediate verbal memory and delayed verbal memory, and immediate visual memory and delayed visual memory. For these we also use the Wechsler scales.

We look at verbal memory, using contextual cues, such as prose passages, and at rote verbal learning using a word-list learning task. For visual memory, we most commonly look at memory of geometric designs, both immediate and delayed, and occasionally at memory of faces and spatial memory. The Wechsler scales are the most frequently used, and sometimes we use the Rey Complex Figure Test.


	Memory Functioning Verbal memory Wechsler Memory Scale-Revised Wechsler Memory Scale-III Logical Memory I and II (prose) Word-List Learning Selective Reminding Test California Verbal Learning Test Visual memory Wechsler Memory Scale-Revised Wechsler Memory Scale-III Visual Reproduction I and II: memory for geometric designs Rey Complex Figure (copy and delay)

	Neuropsychological tests look at verbal memory in context, using cues such as prose passages, and at rote verbal-learning tasks, using a word-list learning task. Visual memory is assessed in neuropsychological testing by memory of geometric designs, memory of faces, and spatial memory. Courtesy of Penne Sims, Ph.D.

We look at language functioning for both receptive and expressive language by assessing auditory comprehension, repetition of words, phrases and sentences, and confrontation naming.

To assess visual-spatial skills, or how the individual processes visual stimuli, we look at spatial orientation and visual construction. You may be familiar with the test in which a patient draws a clock to command and to copy. To evaluate executive functioning, we look at how or whether someone is able to initiate, monitor, and complete a task. For motor functioning we look at speed, dexterity, and strength. To assess personality with respect to dementia, we screen for mood disorders, psychosis, and sometimes personality disorders.

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