The Assessment of Change: Serial Assessments in Dementia Evaluations

Abstract

The focus of the clinical neuropsychologist in everyday practice is on neurocognitive change. Because the diagnosis of dementia as well as mild cognitive impairment requires evidence of cognitive decline over time, the assessment of meaningful neurocognitive change is especially relevant in the evaluation of older adults, especially within the context of today’s value-driven, evidence-based healthcare system (Chelune GJ (2017) Evidence-based practices in neuropsychology. In: Bowden S (ed) Neuropsychological assessment in the age of evidence-based practice. Oxford, New York). We briefly discuss the clinical use of norm-referenced tests used in traditional single-point assessments and then focus on the use of serial assessments to objectively monitor and assess cognitive changes over time, discussing the unique advantages and challenges of serial assessments. An overview and distillation of reliable change methods are presented and applied to a case example, demonstrating how these methods can be used as effective tools to inform the clinical evaluation of the individual patient. In the end, we hope to leave the reader with an appreciation that change is a unique variable with its own inherent statistical properties and clinical meaning.