Alzheimer's disease, or another type of dementia is
suspected, the person will often be referred to a psychologist for a neuropsychological assessment. Neuropsychologists are important in making an accurate diagnosis because they specialize in the diagnostic assessment and treatment of patients with neurocognitive deficits and brain damage. They can help other clinicians find out what type of dementia, or coexisting types of dementia, someone may have, as well as distinguish between, for example, depression and dementia. They look at the relationship between the brain and behavior.
Neuropsychology is a specialist area of clinical psychology and practitioners will undergo extra years of education. In addition to completing a doctoral degree in psychology, they also complete a clinical internship (1 year) and specialized post-doctoral training in clinical neuropsychology.
A Neuropsychology Workup
Neuropsychologists build up a comprehensive picture of a person's cognitive strengths and weaknesses. They do this by:
- Finding out about a person's previous levels of cognitive functioning to see whether there has been any deterioration. They are able to make estimates of previous levels of intellectual function from their employment history and educational attainments. For older people though these are not that reliable as they would not have had the education and work opportunities because of the need to support family member and from the disruption caused by wars in their youth. There are tests available that give a good idea of premorbid (occurring prior to the development of disease) intelligence in early stage Alzheimer's.
- Neuropsychologists carry out screening of core areas of functioning. These areas include language, memory, attention and perception. The tests include the mini-mental state examination (Folstein et al (1987) and CAMCOG part of the Cambridge Mental Disorders of the Elderly Examination (CAMDEX (Roth et al 1986). WAIS 111 (Wechsler) is a screening tool for younger people with suspected dementia as it has a range of age specific norms.
- After the initial screening that identifies areas of difficulty or uncertainty, the neuropsychologist can then carry out further and more detailed assessments. This often involves assessments of memory, visual perception, expressive and receptive language, orientation, ability to plan, organise and carry out tasks.
- If a diagnosis remains uncertain tests can be referred back to compare results. In Alzheimer's a pattern of deterioration in areas of functioning may help firm up a positive diagnosis of a type of dementia or point to the need for further clinical investigation.
- Baselines that have been established from the assessments that contributed to an accurate diagnosis can then be used for future assessments. The baselines can also be the basis for therapeutic programmes that use people's strengths and work on their weaknesses to maximize their potential.
- Repeated assessments can also be very helpful to see if cognitive enhancing drugs such as doneprezil, rivastigmine, galantamine and tacrine are effective.
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Published On: February 17, 2011