Hit or Miss? Diagnostic contributions of neuropsychological assessment in patients with suspected dementia

Abstract

Objectives: Accurate early diagnosis of dementia has important implications for prognosis, treatment, and management. In hospital settings, neuropsychological assessment is frequently included in the diagnostic work-up for dementia, particularly in clinically ambiguous cases. However, the diagnostic contributions of neuropsychological testing in this population are not well established. This paper reports the findings from a preliminary study examining the diagnostic utility of such assessment in patients with suspected dementia. Methods:A retrospective review of hospital medical records was performed for 84 patients who underwent neuropsychological assessment for diagnostic purposes within a five-year time frame. A proxy measure of diagnostic accuracy was obtained using the level of agreement between the neuropsychologist's opinion and the most recent working diagnosis of the medical treatment provider, allowing a minimum follow-up period of twelve months. Results:Using defined clinical coding criteria to account for differences between clinical conditions (e.g., mild neurocognitive disorder) and underlying pathology (e.g., Alzheimer's disease), the baseline diagnosis of the neuropsychologist concurred with the most recent diagnosis of the treatment provider in 88% of cases with an exact match in 77% of cases. Follow-up neuropsychological assessments over time did not lead to a significant improvement in diagnostic accuracy. Conclusion:A high level of diagnostic agreement emerged between neuropsychology and treating medical consultant opinions, independent of available neuroimaging evidence. The findings highlight the contribution of neuropsychological testing in the diagnosis of dementia in hospital settings. Replication of these results is required using prospective designs, larger samples, multiple sites, and autopsy confirmed diagnoses.