Neuropsychological Evaluation of the Older Adult: A Clinician's Guidebook PDF
Preview Neuropsychological Evaluation of the Older Adult: A Clinician's Guidebook
N EU RO PSYC H O LOG ICAL EVALUATION OF THE OLDER ADULT A Clinician's Guidebook I II III III II I NEUROPSYCHOLOGICAL EVALUATION OFTHE OLDER ADULT A Clinician's Guidebook Joanne Green Department of Neurology and Wesley Woods Geriatric Center Emory University School of Medicine ~ ACADEMICP RESS An Imprint of Elsevier San Diego San Francisco New York Boston London Sydney Tokyo This book is printed on acid-free paper. Copyright (cid:14)9 2000 by ACADEMIC PRESS An Imprint of Elsevier All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier's Science and Technology Rights Department in Oxford, UK. Phone (44) 1865 843830, Fax: (44) 1865 853333, e-mail: [email protected]. You may also complete your request on-line via the Elsevier homepage: .http://www.elsevier.com by selecting "Customer Support" and then "Obtaining Permissions". Academic Press An Imprint of Elsevier 525 B Street, Suite 1900, San Diego, California 92101-4495, U.S.A. http://www.academicpress.com Academic Press Harcourt Place, 32 Jamestown Road, London NW 1 7BY, UK http://www.hbuk.co.uk/ap/ Library of Congress Catalog Card Number: 99-68194 ISBN-13:978-0-12-298190-6 ISBN-10:0-12-298190-1 PRINTED IN THE UNITED STATES OF AMERICA 05 SB 9 8 7 6 CONTENTS PREFACE Xl I Activities Preceding Patient Arrival Clarifying the Referral Question 1 The Preevaluation Letter 2 Reviewing Records of Previous History 2 The Clinical Interview Introducing the Evaluation and Establishing Rapport Identifying Concerns about the Patient 8 The General bzquiry 8 The Specific Inquiry 11 Obtaining the Background History 13 Medical History 13 Educational, Occupational, and Family History 17 vi CONTENTS Using the Interview to Evaluate the Patient 18 Awareness of Cognitive Change or Other Unusual Behaviors 18 Affect 19 Expressive and Receptive Language 19 Memory for Personal History 20 Concluding the Interview and Transitioning to Formal Testing 20 3 General Principles and Guidelines for Formal Testing Screening Sensory Abilities 23 Optimizing the Test Environment 24 Orienting the Patient to Testing 25 Guidelines for Use of Psychometrists 26 Principles of Test Design: Reliability and Validity 27 Choosing Normative Data for Older Individuals 30 Selecting the Test Battery 33 4 Evaluation of General Intellectual Function, Attention, Executive Function,Verbal Abilities, and Visuospatial and Visuoconstructive Abilities Assessment of General Intellectual Function 37 Wechsler Adult Intelligence Scale-Ill 37 Wechsler Abbreviated Scale of lntelligence 38 Dementia Rating Scale 39 Tests of Specific Abilities 43 Attention and Executive Function 44 Verbal Abilities 53 Visuospatial and Visuoconstructive Abilities 63 5 Memory Evaluation in OIderAdults Memory Systems: Declarative and Nondeclarative Memory 74 A Model of Remembering New Information 78 Dimensions for Clinical Assessment of Memory 81 Ii CONTENTS VII Test Instruments for Evaluation of Memory 85 WMS-III Information and Orientation 87 WMS-III Logical Memory (LM) 88 WMS-III Word Lists 89 WMS-III Visual Reproduction 90 6 Neuropsychological Profiles of Common Disorders Affecting Older Adults I:Alzheimer's Disease, Frontotemporal Lobar Degeneration Definition of Dementia 93 Cortical and Subcortical Dementia Syndromes 94 Alzheimer's Disease 97 Background 97 Neuropsychological Characteristics of Alzheimer's Disease 101 Alzheimer's Disease Subtypes 103 Neuropsychiatric Symptoms in Alzheimer's Disease 107 Frontotemporal Lobar Degeneration 108 Background 108 Frontotemporal Dementia 109 Progressive Nonfluent Aphasia 111 Semantic Dementia 111 Distinguishing Frontotemporal Lobar Degeneration from Alzheimer's Disease 112 7 Neuropsychological Profiles II:Vascular Disease, Dementia with Lewy Bodies Cerebrovascular Disease and Vascular Dementia 115 Background 115 Neuropsychology of Cerebrovascular Disease 117 Vascular Dementia 122 Differentiating between Vascular Dementia and Alzheimer's Disease 123 Neuropsychiatry of Cerebrovascular Disease 125 Dementia with Lewy Bodies 126 Background 126 Neuropsychological Characteristics of Dementia with Lewy Bodies 127 eee VIII CONTENTS 8 Neuropsychological Profiles II!: Parkinsonian Disorders, Corticobasal Degeneration, Huntington's Disease Parkinson's Disease 129 Diagnosis and Clinical Characteristics 129 Special Issues in Evaluation of Patients with Parkinson's Disease 132 Neuropsychological Function in Parkinson's Disease 133 Variables Affecting Neuropsychological Function in Parkinson's Disease 136 Dementia in Parkinson's Disease 136 Neuropsychiatric Disorder in Parkinson's Disease 138 Other Parkinsonian Syndromes with Neuropsychological Correlates 140 Progressive Supranuclear Palsy 140 Multiple System Atrophy 141 Corticobasal Degeneration 142 Huntington's Disease 143 Neuropsychological Features of Huntington's Disease 144 Neuropsychiatric Features 146 9 Neuropsychological Profiles IV:Traumatic Brain Injury, Substance-Related Disorders, Normal Pressure Hydrocephalus, Metabolic and Toxic Disorders Traumatic Brain Injury 147 Background 147 Neuropsychological Correlates of Traumatic Brain Injury in Older Adults 148 Neuropsychological Differences between Traumatic Brain Injury and Alzheimer's Disease 149 Substance-Related Disorders 149 Background 149 Assessing Substance-Related Disorders during the Clinical Interview 151 Brain Changes Associated with Alcohol-Related Disorders 152 Neuropsychological Changes Associated with Alcohol-Related Disorders 153 Neuropsychological Changes Associated with Medication Use 156 CONTENTS ix Normal Pressure Hydrocephalus 162 Metabolic and Toxic Disorders 164 10 Assessment of Depression during the Neuropsychological Evaluation Criteria for Diagnosing Depression 170 Prevalence, Risk Factors, and Characteristics of Depression in Older Adults 170 Assessing Depression during the Clinical Interview 171 Instruments for Screening for Depression 173 Neuropsychological Profiles of Depression 175 Depression and Brain Disease 176 The Concept of Pseudodementia 177 Differentiating Depression from Alzheimer's Disease 178 Electroconvulsive Therapy and Neuropsychological Change 179 II Organizing and Interpreting Test Findings Computing Raw Test Scores 182 Computing z-Scores 183 Compiling the Neuropsychology Data Summary Sheet 186 Approaches to Estimating Premorbid Abilities 186 Best Performance Method 187 "Hold" Scores 187 Demographic Equations 188 Historical Data 191 Guidelines for Estimating Premorbid Abilities 191 Interpreting Test Findings 195 Interpreting Each Test Score 195 Interpreting Test Scores Relative to Premorbid Ability 196 Identifying the Neuropsychological Profile 198 Identifying Change on Reevaluation 199 12 Writing the Evaluation Report Report Header 201 Referral and Background Information 202 Behavioral Observations 203 Tests Administered 203 Test Results 203 Impressions and Recommendations 203 X CONTENTS 13 Providing Feedback and Planning Follow-up Services Organizing the Feedback Session 206 Clinical Considerations Important to Providing Feedback 207 Describing Neuropsychological Strengths and Weaknesses and Reasons for Change 210 Discussing Treatment Alternatives, Patient Care, and Follow-up Services 211 Addressing Interpersonal and Family System Issues 214 APPENDIXES A. Preevaluation Letter 217 B. Informed Consent for Neuropsychological Evaluation 219 C. Neuropsychological Interview 221 D. Behavioral Observations 223 E. Neuropsychology Data Summary Sheet 225 E Outline of the Report of the Neuropsychological Evaluation 229 G. Patient Cases 231 H. Basic Brain Neuroanatomy 253 I. List of Abbreviations 255 REFERENCES 257 INDEX 303
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