Neuropsychological Evaluation of the Older Adult: A Clinician's Guidebook

326 Pages·2000·17.23 MB·English

by  Joanne Green

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
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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