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 demen-tia, 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 neuropsy-chological 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 neuro-cognitive disorder) and underlying pathology (e.g., Alzheimer's disease), the baseline diagnosis of the neuropsycholo-gist 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 neuro-psychological 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.