Neuropsychology

Certain conditions, such as depression and anxiety can impair cognitive function. For this reason, cognitive impairment in these conditions should be tested for. Examples include the Spielberger Questionnaire for State Anxiety and the Beck Questionnaire for Depression. These questionnaires are completed by the patients themselves.

The questionnaire consists of two parts: the first block of 20 questions relates to the patient's current feelings of anxiety at the time of completing the questionnaire. The second block, also consisting of 20 questions, is designed to assess the general anxiety experienced by the patient in their daily life.

Assessment (to be calculated separately for each part):

• <45 points: no or mild anxiety
• 45-60 points: moderate anxiety
• 61-80 points: severe anxiety

The questionnaire consists of 13 questions and takes about 10 minutes to complete. It provides information about the respondent's perspective and the presence or absence of symptoms of depression.

Assessment:

• 0-5 points: normal
• 6-11 points: mild
• 12-15 moderately severe
• ≥15: severe

The trail-making test tests the function of the frontal lobe. It provides information on a range of cognitive functions such as alternating attention, cognitive flexibility, motor speed and visual search. Test A requires the completer to connect circles of 25 numbers in ascending order. Test B is similar in appearance to Test A, but this time the completer has to alternate between circles of numbers and circles of letters, in ascending order for numbers and alphabetical order for letters.

Assessment:

• Test A abnormal: >79 seconds
• Test B abnormal: >273 seconds

During the test the examiner reads a list of fifteen words and then asks the subject to recall these words. During recall, the words can be recalled in any order. This sequence of events is repeated four more times, followed by a new list of fifteen words. The initial list is then recalled again, followed by the initial list after a 30-minute delay. The subject is then asked to select the fifteen words from the initial list from a 30-word list. The test is designed to assess the function of the hippocampus area of the temporal lobe brain by testing immediate and delayed recall and recognition memory.

Assessment:

• First five recalls are abnormal if
  • <39 - 50-59 years of age
  • <35 - between 60-69 years of age
  • <29 - over 70 years of age
• Delayed recall results are abnormal if
  • <6 - between 50 and 59 years of age
  • <5 - between 60-69 years of age
  • <4 - over 70 years of age

The Addenbrooke's Cognitive Examination assesses six cognitive domains: orientation, concentration, memory, language skills, verbal fluency and spatial-visual skills. It examines the function of the frontal, temporal, parietal and occipital lobes. It is widely used in the diagnosis and differential diagnosis of mild cognitive impairment and dementia. The VLOM ratio (Verbal-Language/Orientation-Memory) is used to help differentiate Alzheimer's disease from frontotemporal dementia. The maximum score is 100 points and the test takes 30-60 minutes to complete.

Assessment:

• Total score abnormal: <84
• VLOM ratio abnormal: 3.2

The MMSE is a test to screen for cognitive decline and monitor progression. It tests orientation, concentration, language skills, memory and spatial-visual skills. It takes 5-10 minutes to complete.

Assessment:

• abnormal: <26
  • 21-25: mild dementia
  • 11-20: moderate dementia
  • <11: severe dementia

The Alzheimer's Disease Assessment Scale consists of two sections, the cognitive (-Cog) and non-cognitive (-Noncog) sections. The cognitive test assesses orientation, memory, language skills and motor planning function. It can be used to differentiate between healthy individuals and patients as well as between different stages of Alzheimer's disease. The maximum score available is seventy points, with a lower score indicating better performance. It takes 30-35 minutes to complete.

Assessment:

• ≥4: mild cognitive impairment
• ≥12: Alzheimer's disease

The Montreal Cognitive Assessment is a 30-question screening test to assess the presence of symptoms of dementia. It assesses orientation, short-term memory, focus and spatial awareness, language skills, concentration and spatial-visual skills. It takes 10-12 minutes to complete.

Assessment:

• <25 points: risk of dementia

The CDR scale is completed by the examiner clinician, who assesses the severity of dementia symptoms in six domains. These six domains are memory, orientation, judgment and problem solving, social life, hobbies and home activities, and self-care.

Assessment

• 0: no dementia
• 0,5: dementia suspected
• 1: mild dementia
• 2: moderate dementia
• 3: severe dementia