Individual Variability in Clinical Decision Making and Diagnosis
Pat Croskerry, Karen S. Cosby, Mark L. Graber, Hardeep Singh in Diagnosis, 2017
Given that the clear majority of diagnostic errors are due to various cognitive failures [53–56], we would expect that anything associated with cognitive impairment would, in turn, impair diagnostic performance. Some neurodegenerative diseases and syndromes that are age-related, such as dementia, Alzheimer’s disease, frontotemporal dementia, vascular dementia, and transient global amnesia [57], would all be associated with cognitive deficits to varying degrees and differentially affect particular areas of the brain and their associated cognitive functions. It would be expected that these conditions would quickly become evident, but early changes may be subtle and attributed to the effects of fatigue, stress, sleep loss, and other variables. It is said that “When true impairment in clinical skills is apparent, the illness is usually severe and longstanding” [58]. Once disease is diagnosed, neuropsychological assessment is useful in localizing brain lesions and assessing functional abilities, and neuropsychiatric assessment can focus on the relationship between the disorder and mental symptoms. Diagnosis may be difficult, with some cases requiring positron emission tomography scans before the anatomic lesion is identified. So, the first point is that if a physician has an age-related neurodegenerative disease, deficits in cognition might impair decision making and lead to diagnostic error before the condition is diagnosed.
Australian Rules Football and Rugby League
Mark R. Lovell, Ruben J. Echemendia, Jeffrey T. Barth, Michael W. Collins in Traumatic Brain Injury in Sports, 2020
One of the benefits of assessing the effects of concussion in contact sport is the ability to collect pre-injury data on cognitive function. Concussed players can be reassessed and compared to their own pre-injury performance. Analyses of within-subject variations in performance are far more powerful than between subject differences or comparisons to non-specific normative data (Brooks, 1987). However, preseason screening of contact sport players must be undertaken within a limited window of opportunity. To assess a large group of people within a brief period, session length must be considered. All prospective studies to date have limited assessment schedules to 30-45 minutes, far more brief than the regular neuropsychological assessment. Finally, given pre-season data, recovery of function may be considered on an individual basis. None of the group-analysed studies of concussion in sport have provided adequate criteria for making individual decisions.
Neuropsychological Assessment of Alcohol-Related Cognitive Impairment
Jenny Svanberg, Adrienne Withall, Brian Draper, Stephen Bowden in Alcohol and the Adult Brain, 2014
The referral may contain a wealth of information or very little, and it may be useful to clarify the particular question(s) for which the referrer is seeking answers. It can also be useful to review the patient's medical records, with consent, particularly in cases where there has been a lengthy history. Information on the trajectory of any cognitive changes will be contained within records, and brain imaging may have been carried out in the past. The neuropsychological assessment is an opportunity to formulate information from medical, psychological and social domains and consider how these may impact on cognition, mood behavior and everyday functioning.
CSIS: Proposal for a New Combined Screening Interpretation Score for Patients with Mild Cognitive Impairment
Published in Experimental Aging Research, 2021
María Josefina Gonzalez Aguilar, Lucía Alba Ferrara
Albert et al. (2011) define four cognitive and clinical criteria for MCI that include: concern regarding a change in the patient’s condition, objective impairment in one or more cognitive domains, preservation of independence in functional abilities and absence of dementia. MCI is often the precursor of a dementia, but as the authors state “sharp demarcations between normal cognition and MCI, and between MCI and dementia are difficult, and clinical judgment must be used to make these distinctions” (p. 271). Neuropsychological assessment is an optimal way to study objectively the cognitive performance and the degree of cognitive impairment of an individual. Thus, neuropsychological screening tools for the identification of MCI not only would collaborate with the diagnosis, but would also aid to estimate globally the prevalence, incidence, risk and associated morbidity of this pathology. Although there is no scientific evidence of a specific pharmacological treatment for MCI to prevent its progression to dementia (Cooper, Li, Lyketsos, & Livingston, 2013; Li, Dai, Zhao, Liu, & Li, 2018) identifying dementia prodromes is crucial for future treatment efforts. Therefore, it is vital to study an effective, brief and sensitive screening score, feasible to be applied by health professionals in a context of primary care for the detection of cognitive impairment in older adults, considering both the extension in life expectancy in the elderly and the impact that these pathologies have on a family and economic level (Mías, Sassi, Masih, Querejeta, & Krawchik, 2007).
Neuropsychological Risk Factors to Consider When Assessing for Sexually Abusive Youth
Published in Journal of Child Sexual Abuse, 2018
Trisha M. Karsten, Rachyll Dempsey
Psychological assessment is a broad term for cognitive, academic, and personality testing. Psychological assessment is often warranted for diagnostic clarification, treatment planning, personal insight, and placement. Only individuals with appropriate training, which in many cases is a licensed doctoral-level psychologist, are qualified to conduct psychological testing. Referrals for a psychological assessment are warranted for sexually abusive youth if there is a question about cognitive functioning, academic achievement, learning disability, or differential diagnosis. Neuropsychological assessment is a more focal assessment that is warranted in cases of head injury, in utero exposure to drugs/alcohol, degenerative disorders, or early childhood abuse. Neuropsychological assessment is a specialized type of assessment that explores the following: memory (immediate, delayed, visual, auditory), executive functioning (planning, organization, attention, inhibition/impulsivity), visuospatial/visual constructional (visual problem solving, hand/eye coordination), language (verbal fluency, confrontation naming, word finding), and sensory motor ability (Lezak, Howieson, Loring, & Fischer, 2004). Further, neuropsychological assessment includes intellectual functioning and emotional functioning in order to rule out other issues that may be impairing an individual’s neuropsychological functioning (Lezak et al., 2004). Referrals for a neuropsychological assessment are warranted for sexually abusive youth if there is a question about neuropsychological functioning or differential diagnosis.
Neuropsychological assessment without upper limb involvement: a systematic review of oral versions of the Trail Making Test and Symbol-Digit Modalities Test
Published in Neuropsychological Rehabilitation, 2018
Abhishek Jaywant, Jennifer Barredo, David C. Ahern, Linda Resnik
Neuropsychological assessment is a critical component of the management and rehabilitation of disorders that affect neurological and physical functioning (Kalmar et al., 2008). In rehabilitation settings, attention, processing speed, and executive functions predict safety and recovery from disability (Pastorek, Hannay, & Contant, 2004; Rapport, Hanks, Millis, & Deshpande, 1998), functional independence following traumatic brain injury (Bercaw, Hanks, Millis, & Gola, 2011), and the ability to use an advanced prosthesis following upper limb amputation (Hancock, Correia, Ahern, Barredo, & Resnik, 2016). In inpatient settings, assessment is typically limited to brief evaluations. This increases the imperative on clinicians to select neuropsychological measures that have strong validity and reliability, and carefully developed normative data along relevant sociodemographic variables (American Psychological Association, 2014).
Related Knowledge Centers
- Neurological Disorder
- Neuroimaging
- Cognition
- Neuropsychology
- Neuropsychological Test
- Mental Status Examination
- Alzheimer's Disease
- Dementia
- Executive Functions
- Clinical Neuropsychology