Neuropsychological Testing - When To See A Doctor: Improving Memory Understanding Age Related Memory Loss

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Neuropsychological testing

If your symptoms warrant a more comprehensive evaluation, your physician may refer you to a neuropsychologist, a doctor who specializes in the relationship between brain and behavior. This specialist may practice independently or at a medical center. A neuropsychological examination begins with a thorough review of your history as well as a review of the diagnostic studies and tests that you've already had. Neuropsychologists typically use a battery of paper-and-pencil tests of mental abilities to comprehensively evaluate your cognitive function. The tests assess attention, memory, executive functions, language, and spatial ability. The doctor may also use tests or questionnaires to gauge your mood. Not all neuropsychologists use the same tests, but they all look at this same spectrum of mental functions. A technician may help administer the tests.

The neuropsychologist will interpret and analyze the test results in light of your age, level of education, and other variables that influence cognitive ability and memory capacity, as well as in the context of your medical history and other diagnostic studies. That way, he or she can determine if the findings suggest a specific type of disorder or if they reflect normal age-related changes in cognitive function. Following are the kinds of tests that are used.

Testing attention

Failure to pay close enough attention is one of the primary reasons people fail to learn new information — they never absorbed it completely in the first place. There are many tests that can be used to assess attention. In one example, the neuropsychologist might read you a sequence of numbers and then have you repeat back as many as you can remember.

Testing memory

Memory testing usually requires that you listen to or view some information and answer questions about it or reproduce it immediately afterward, and then again 10–30 minutes later. Some memory tests entail learning and remembering visual information, such as a picture that you were asked to study or a design you were asked to copy (see Figure 6). The neuropsychologist might also test your long-term memory by asking you questions about your personal history or factual information you may have learned in the past, comparing it to information gathered from medical records or other sources.

Figure 6: Draw this picture A picture like this one is commonly used to evaluate visual memory. Study this illustration for 30 seconds and then put it away. Then draw as much of the picture as you can from memory. The better your visual memory, the more of the picture you will be able to reproduce. People with Alzheimer's disease will recall little of this drawing even if they copied it correctly. If after performing this test you are concerned about your memory, it is important to have an evaluation, as some causes of memory difficulty are treatable (see "The first step").

Testing executive functions

Executive functions are high-level mental functions that involve the overall regulation of thought and behavior, such as reasoning, problem-solving, planning, initiation, and inhibiting impulses in order to stay focused on a task. You use executive functions even when doing simple things like following a recipe. These functions are among the first to become impaired in people with Alzheimer's disease.

One assessment of executive functions is the Trail-Making Test. The first phase of this paper-and-pencil test shows circles, each with a number inside it. The test-taker must connect the circles in numerical order. On the second phase there are circles containing either a number or a letter. In this case, the test-taker connects the circles by alternating between the numbers and the letters: 1 to A to 2 to B, and so on. The test is scored according to speed and accuracy.

Executive functions are also important in appreciating the subtle, implicit "rules" that guide social interaction — for example, exhibiting normal consideration for others and the motivation to engage with them. People who are having difficulty in this area are often unaware of the problem; family members may be the first to notice a "personality change." These types of problems with executive functions are usually not assessed through testing but rather through direct observation and discussion with family members.

Testing language

Language functions include the abilities to express yourself through speaking and writing and to understand what another person is saying or what you are reading. The neuropsychologist may ask you to name common objects or pictured items. Problems with naming and word-finding can be early symptoms of Alzheimer's disease. You may be asked to follow instructions as a way of determining if you understand what's being said. You may also be asked to read a brief paragraph, repeat phrases, or describe a picture in writing.

Testing spatial ability

Spatial ability includes analyzing visual information such as shapes, faces, and routes between locations on a map. Because the right side of the brain plays a primary role in analyzing spatial information, people who are having difficulty with this type of function may have a condition that has damaged the right hemisphere, such as a stroke. Although it is relatively uncommon, there is a "visual variant" of Alzheimer's disease, which begins with symptoms that suggest right-sided brain dysfunction. Spatial ability tests include drawing and copying designs, solving maze puzzles, and putting blocks together to construct a specific pattern.

Last updated:	January 23, 2007