By Dr. Anthony Policastro

Last week I wrote about neuropsychological testing in schools. Some people may have the perception that these tests are only useful in a school setting. That is not true.

There are many neurological conditions that are marked by a deterioration in performance over time. These kinds of tests allow that deterioration to be documented. They are almost like lab tests for chronic medical conditions that are not neurological.

A good example of this is following a patient with dementia. Neuropsychological testing in older adults has two roles. One of them is making a diagnosis of problems. Another is following changes over time. The latter is not much different than what is done every three years in schools.

Testing might not need to be done quite that often in adults. Just as in children, there are multiple parts to the testing.

The first part is as you might expect. An overall intelligence test to determine if the individual is performing at 100 percent of what is expected for their age is the starting point. Again the expectation is that the average individual will have a score somewhere between 90 percent of expected and 110 percent of expected.

In children that number does not change over time. However, in adults that might not be the case. There may be some drop-off just because of normal aging. There might also be decreases over time because of advancing dementia. Thus a baseline intelligence test gives a useful starting point.

Other testing does not focus on reading, writing and math as it does in schoolchildren. It looks at a variety of skills in multiple areas.

These include memory testing. This is certainly important in individuals with suspected dementia. Memory skills have multiple parts. They include things like recalling facts. They include things like remembering how to do complex tasks. They include things like recognizing what things are used for when they are named. For example, what a thermometer is used for.

There is long term memory. That is the ability to recall long known facts. Your address and phone number fit into this category. There is immediate memory. That is the ability to remember something you have just been told. It might involve learning a phone number or e-mail address. You then have to remember to immediately use it.

Most memory skills are short term in nature. They involve recalling facts that we have learned at one point or another but do not use often. Someone with good short term memory would be a good Jeopardy player.

Another form of memory is recognition memory. This is the ability to recognize the correct item out of a group. It is what multiple choice tests involved. People with poor recognition have problems with that type of testing.

We have auditory memory to remember things we heard. We have visual memory to remember things we have seen.

There are also many non memory direct skills that are tested. They include things like attention. They involve processing speed. They involve visuospatial skills. They involve language skills. There are many others as well.

A good neuropsychiatric battery when a diagnosis of dementia is first suspected can help follow skill levels over time. It is not a lot different that the episodic testing done for learning disabilities. The key difference is we want to try and make learning disabilities better. That is why we repeatedly test. 

In dementia, we expect things to get worse over time. We just do not want that to happen too quickly. Getting changes over time from neuropsychiatric testing is one way of doing that.