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The test results are compared to standardized norms and estimates of the person's pre-injury abilities. A neuropsychological evaluation is often completed soon after an individual has a traumatic brain injury or if an individual seems to be having difficulties related to an undiagnosed brain injury from the past.

Neuropsychological assessment was traditionally carried out to assess the extent of impairment to a particular skill and to attempt to determine the area of the brain which may have been damaged following brain injury or neurological illness. With the advent of neuroimaging techniques, location of space-occupying lesions can now be more accurately determined through this method, so the focus has now moved on to the assessment of cognition and behaviour, including examining the effects of any brain injury or neuropathological process that a person may have experienced.

A core part of neuropsychological assessment is the administration of neuropsychological tests for the formal assessment of cognitive function, though neuropsychological testing is more than the administration and scoring of tests and screening tools. It is essential that neuropsychological assessment also include an evaluation of the person's mental status. This is especially true in assessment of Alzheimer's disease and other forms of dementia.^[1] Aspects of cognitive functioning that are assessed typically include orientation, new-learning/memory, intelligence, language, visuoperception, and executive function. However, clinical neuropsychological assessment is more than this and also focuses on a person's psychological, personal, interpersonal and wider contextual circumstances.

Assessment may be carried out for a variety of reasons, such as:

• Clinical evaluation, to understand the pattern of cognitive strengths as well as any difficulties a person may have, and to aid decision making for use in a medical or rehabilitation environment.
• Scientific investigation, to examine a hypothesis about the structure and function of cognition to be tested, or to provide information that allows experimental testing to be seen in context of a wider cognitive profile.
• Medico-legal assessment, to be used in a court of law as evidence in a legal claim or criminal investigation.

Miller outlined three broad goals of neuropsychological assessment. Firstly, diagnosis, to determine the nature of the underlying problem. Secondly, to understand the nature of any brain injury or resulting cognitive problem (see neurocognitive deficit) and its impact on the individual, as a means of devising a rehabilitation programme or offering advice as to an individual's ability to carry out a certain tasks (for example, fitness to drive, or returning to work). And lastly, assessments may be undertaken to measure change in functioning over time, such as to determine the consequences of a surgical procedure or the impact of a rehabilitation programme over time.^[2]

Diagnosis of a neuropsychological disorder[edit]

Certain types of damage to the brain will cause behavioral and cognitive difficulties. Psychologists can start screening for these problems by using either one of the following techniques or all of these combined:

History taking[edit]

This includes gathering medical history of the patient and their family, presence or absence of developmental milestones, psychosocial history, and character, severity, and progress of any history of complaints. The psychologist can then gauge how to treat the patient and determine if there are any historical determinants for his or her behavior.

Interviewing[edit]

Psychologists use structured interviews in order to determine what kind of neurological problem the patient might be experiencing. There are a number of specific interviews, including the Short Portable Mental Status Questionnaire, Neuropsychological Impairment Scale, Patient's Assessment of Own Functioning, and Structured Interview for the Diagnosis of Dementia.^[3]

Test-taking[edit]

Scores on standardized tests of adequate predictive validity predictor well current and/or future problems. Standardized tests allow psychologists to compare a person's results with other people's because it has the same components and is given in the same way. It is therefore representative of the person's's behavior and cognition. The results of a standardized test are only part of the jigsaw. Further, multidisciplinary investigations (e.g. neuroimaging, neurological) are typically needed to officially diagnose a brain-injured patient.^[4]

Intelligence testing[edit]

Testing one's intelligence can also give a clue to whether there is a problem in the brain-behavior connection. The Wechsler Scales are the tests most often used to determine level of intelligence. The variety of scales available, the nature of the tasks, as well as a wide gap in verbal and performance scores can give clues to whether there is a learning disability or damage to a certain area of the brain.^[3]

Testing other areas[edit]

Other areas are also tested when a patient goes through neuropsychological assessment. These can include sensory perception, motor functions, attention, memory, auditory and visual processing, language, problem solving, planning, organization, speed of processing, and many others. Neuropsychological assessment can test many areas of cognitive and executive functioning to determine whether a patient's difficulty in function and behavior has a neuropsychological basis.^[5]

Information gathered from assessment[edit]

Tsatsanis and Volkmar believe that assessment can provide unique information about the type of disorder a patient has which allows the psychologist to come up with a treatment plan. Neuropsychological assessment can clarify the nature of the disorder and determine the cognitive functioning associated with a disorder. Assessment can also allow the psychologist to understand the developmental progress of the disorder in order to predict future problems and come up with a successful treatment package. Different assessments can also determine if a patient will be at risk for a particular disorder. It is important to remember, however, that assessing a patient at one time is not enough to go ahead and continue treatment because of the changes in behavior that can occur frequently. A patient must be retested multiple times in order to make sure that the current treatment is still the right treatment. For neuropsychological assessments, researchers discover the different areas of the brain that is damaged based on the cognitive and behavioral aspects of the patient.^[4]

Benefits of assessment[edit]

The most beneficial factor of neuropsychological assessment is that is provides an accurate diagnosis of the disorder for the patient when it is unclear to the psychologist what exactly he/she has. This allows for accurate treatment later on in the process because treatment is driven by the exact symptoms of the disorder and how a specific patient may react to different treatments. The assessment allows the psychologist and patient to understand the severity of the deficit and to allow better decision-making by both parties.^[6] It is also helpful in understanding deteriorating diseases because the patient can be assessed multiple times to see how the disorder is progressing.

One area where neuropsychological assessments can be beneficial is in forensic cases where the defendant's competency is being questioned due to possible brain injury or damage. A neuropsychological assessment may show brain damage when neuroimaging has failed. It can also determine whether the individual is faking a disorder (malingering) in order to attain a lesser sentence.^[7]

Most neuropsychological testing can be completed in 6 to 12 hours or less. This time, however, does not include the role of the psychologist interpreting the data, scoring the test, making formulations, and writing a formal report.^[7]

Qualifications for conducting assessments[edit]

Neuropsychological assessments are usually conducted by doctoral-level (Ph.D., Psy.D.) psychologists trained in neuropsychology, known as clinical neuropsychologists. The definition and scope of a clinical neuropsychologist is outlined in the widely accepted Houston Conference Guidelines.^[8] They will usually have postdoctoral training in neuropsychology, neuroanatomy, and brain function. Most will be licensed and practicing psychologists in their particular field.^[4] Recent developments in the field allow for highly trained individuals such as psychometrists to administer selected instruments, though determinations regarding testing results remain the responsibility of the doctor.

See also[edit]

• Psychological testing such as psychometrics

References[edit]

1. ^Gregory, Robert. 'Psychological Testing, 5th ed.'. Pearson, 2007, p.466.
2. ^Miller, E. (1992) Some basic principles of neuropsychological assessment. In J.R. Crawford, D.M. Parker, W.M. McKinlay (eds) A handbook of neuropsychological assessment. Hove: Laurence Erlbaum Associates. ISBN0-86377-274-9
3. ^ ^ab'Neuropsychological Assessment'. St. John's University.
4. ^ ^abcTsatsanis & Volkmar. 'Unraveling the Neuropsychological Assessment'(PDF). The Source.
5. ^'Neuropsychological Assessment'. New York Assessment. December 2015. Retrieved February 2016.Check date values in: access-date= (help)
6. ^'Neuropsychological and Psychoeducational Testing for Children and Adults'. New York Assessment. December 2015. Retrieved February 2016.Check date values in: access-date= (help)
7. ^ ^abBurke, Harold L. 'Benefits of Neuropsychological Assessment'.
8. ^'THE HOUSTON CONFERENCE ON SPECIALTY EDUCATION AND TRAINING IN CLINICAL NEUROPSYCHOLOGY'(PDF). American Academy of Clinical Neuropsychology. September 1997. Retrieved February 2016.Check date values in: access-date= (help)

Further reading[edit]

• Baer, Lee; Blais, Mark A., eds. (3 October 2009). Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health. Springer. ISBN978-1-58829-966-6. Retrieved 17 June 2014.
• Davis, Andrew, ed. (2011). Handbook of Pediatric Neuropsychology. New York: Springer Publishing. ISBN978-0-8261-0629-2. Retrieved 28 May 2013. Lay summary – Archives of Clinical Neuropsychology (17 June 2014).
• Lezak, Muriel D.; Howieson, Diane B.; Bigler, Erin D.; Tranel, Daniel (2012). Neuropsychological Assessment (Fifth ed.). Oxford: Oxford University Press. ISBN978-0-19-539552-5. Retrieved 17 June 2014. Lay summary – Journal of the International Neuropsychological Society (17 June 2014).CS1 maint: ref=harv (link)
• Loring, David W., ed. (1999). INS Dictionary of Neuropsychology. New York: Oxford University Press. ISBN978-0-19-506978-5. Lay summary (21 November 2010).CS1 maint: ref=harv (link) This standard reference book includes entries by Kimford J. Meador, Ida Sue Baron, Steven J. Loring, Kerry deS. Hamsher, Nils R. Varney, Gregory P. Lee, Esther Strauss, and Tessa Hart.
• Miller, Daniel C. (3 January 2013). Essentials of School Neuropsychological Assessment (2nd ed.). John Wiley & Sons. ISBN978-1-118-17584-2. Retrieved 9 June 2014.CS1 maint: ref=harv (link)
• Reddy, Linda A.; Weissman, Adam S.; Hale, James B., eds. (2013). Neuropsychological Assessment and Intervention for Youth: An Evidence Based Approach to Emotional and Behavioral Disorders. American Psychological Association. ISBN978-1-4338-1266-8. OCLC810409783. Retrieved 15 June 2014.CS1 maint: ref=harv (link) This collection of articles for practitioners includes chapters by Linda A. Reddy, Adam S. Weissman, James B. Hale, Allison Waters, Lara J. Farrell, Elizabeth Schilpzand, Susanna W. Chang, Joseph O’Neill, David Rosenberg, Steven G. Feifer, Gurmal Rattan, Patricia D. Walshaw, Carrie E. Bearden, Carmen Lukie, Andrea N. Schneider, Richard Gallagher, Jennifer L. Rosenblatt, Jean Séguin, Mathieu Pilon, Matthew W. Specht, Susanna W. Chang, Kathleen Armstrong, Jason Hangauer, Heather Agazzi, Justin J. Boseck, Elizabeth L. Roberds, Andrew S. Davis, Joanna Thome, Tina Drossos, Scott J. Hunter, Erin L. Steck-Silvestri, LeAdelle Phelps, William S. MacAllister, Jonelle Ensign, Emilie Crevier-Quintin, Leonard F. Koziol, and Deborah E. Budding.
• Riccio, Cynthia A.; Sullivan, Jeremy R.; Cohen, Morris J. (28 January 2010). Neuropsychological Assessment and Intervention for Childhood and Adolescent Disorders. John Wiley & Sons. doi:10.1002/9781118269954. ISBN978-0-470-18413-4. Lay summary (15 June 2014).CS1 maint: ref=harv (link)
• Strauss, Esther; Sherman, Elizabeth M.; Spreen, Otfried (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford: Oxford University Press. ISBN978-0-19-515957-8. Retrieved 14 July 2013.CS1 maint: ref=harv (link)
• Sherman, Elizabeth M.; Brooks, Brian L., eds. (2012). Pediatric Forensic Neuropsychology (Third ed.). Oxford: Oxford University Press. ISBN978-0-19-973456-6. Retrieved 14 July 2013. Lay summary – Archives of Clinical Neurology (17 June 2014).CS1 maint: ref=harv (link)
• Whishaw, Ian Q.; Kolb, Bryan (1 July 2009). Fundamentals of human neuropsychology (Sixth ed.). New York: Worth Publishers. ISBN978-0-7167-9586-5. Archived from the original on 17 April 2014. Retrieved 17 June 2014. Lay summary(PDF) – Journal of Undergraduate Neuroscience Education (18 July 2010).CS1 maint: ref=harv (link)

External links[edit]

• Media related to Neuropsychological assessment at Wikimedia Commons
• UNC School of Medicine Department of Neurology (24 February 2011). 'Neuropsychological Evaluation FAQ'. University of North Carolina Chapel Hill. Retrieved 17 June 2014.

The Addenbrooke's Cognitive Examination (ACE) and its subsequent versions (Addenbrooke's Cognitive Examination-Revised, ACE-R^[1] and Addenbrooke's Cognitive Examination III, ACE-III) are neuropsychological tests used to identify cognitive impairment in conditions such as dementia.

History[edit]

The Addenbrooke’s Cognitive Examination ^[2] was originally developed as a theoretically motivated extension of the Mini-Mental State Examination (MMSE)^[3] which attempted to address the neuropsychological omissions and improve the screening performance of the latter.^[4]

The ACE encompassed tests of five cognitive domains: attention/orientation, memory, language, verbal fluency, and visuospatial skills.^[2] It is scored out of 100, with a higher score denoting better cognitive function. At the recommended cut-off scores of 88 and 83, the ACE was reported to have good sensitivity and specificity for identifying different forms of dementia and other impairments of memory and judgement (0.93 and 0.71; 0.82 and 0.96, respectively).^[5] The ACE also incorporated the MMSE, such that this score (out of 30) might also be generated.^[2][4]

The ACE-R^[6] was a development of the earlier ACE which also incorporated the MMSE, but had clearly defined subdomain scores.

The ACE-III^[7] was developed to improve the performance of certain parts of the test and also to avoid a potential copyright violation by replacing the elements shared with the MMSE.^[8]

Addenbrooke's Cognitive Examination-III[edit]

The current version of the test is the Addenbrooke's Cognitive Examination-III (ACE-III). This consists of 19 activities which test five cognitive domains: attention, memory, fluency, language and visuospatial processing.

Attention[edit]

Attention is tested by asking the patient for the date including the season and the current location; repeating back three simple words; and serial subtraction.An example would be something like 'subtract seven from 100 and then continue subtracting seven away from each new number.'

Memory[edit]

Memory is tested by asking the patient to recall the three words previously repeated; memorising and recalling a fictional name and address; and recalling widely known historical facts.The memory section is split into five sections scattered throughout the tests.^[9]

Fluency[edit]

Fluency is tested by asking the patient to say as many words as they can think of starting with a specified letter within one minute; and naming as many animals as they can think of in one minute. An example of this would be the tester asking the test taker to list every word they can think of that starts with the letter C.

Language[edit]

Language is tested by asking the patient to complete a set of sequenced physical commands using a pencil and piece of paper such as 'place the paper on top of the pencil'; to write two grammatically-complete sentences; to repeat several polysyllabic words and two short proverbs; to name the objects shown in 12 line drawings, and answer contextual questions about some of the objects; and to read aloud five commonly-mispronounced words. Language involves ascribing meaning to words and statements so this section consists of simple directions that may involve movements, such as the example of placing the paper on top of the pencil, to see how well they apply meaning. Because language is valuable and important to functioning in society, which is why this section is the longest consisting of seven separate parts.^[10]

Visuospatial[edit]

Visuosaptial skills are used almost daily to remember directions, addresses, and layout of familiar places.^[11]Visuospatial abilities are tested by asking the patient to copy two diagrams; to draw a clock face with the hands set at a specified time; to count sets of dots; and to recognize four letters which are partially obscured.

Scoring[edit]

The results of each activity are scored to give a total score out of 100 (18 points for attention, 26 for memory, 14 for fluency, 26 for language, 16 for visuospatial processing). The score needs to be interpreted in the context of the patient's overall history and examination, but a score of 88 and above is considered normal; below 83 is abnormal; and between 83 and 87 is inconclusive.

Validity[edit]

In the initial validation study^[7] the cohort examined (n = 86; AD 28, FTD 33, controls 25) found the ACE-III to be acceptable and relatively quick to administer (15 min). The ACE-III and ACE-R were highly correlated (r = 0.99), and at the previously recommended cut-off scores (88 and 82) the ACE-III was both highly sensitive and specific (at 88/100: 1.00 and 0.96 respectively; at 82/100: 0.93 and 1.00 respectively). At the cut-off of 88, Elamin and colleagues^[12] found the ACE-III distinguished early-onset dementia from healthy controls with high sensitivity (0.915) and specificity (0.964), and also from subjective memory impairment with high sensitivity (0.915) and specificity (0.867). The ACE-III has been validated against standard neuropsychological tests and has been shown to be a valid cognitive screening tool for dementia syndromes.^[7][13]

Translations and localised versions[edit]

The ACE-III questionnaire has been translated into 19 languages. The English-language version has been localised for users in Australia, India, The United States, The United Kingdom, and New Zealand. ^[14]

Mini-ACE[edit]

In 2014, a shorter version of the ACE-III, the Mini-ACE (M-ACE), was developed and validated.^[15] It comprises tests of attention, memory (7-item name and address), letter fluency, clock drawing, and memory recall, and takes under five minutes to administer. The M-ACE is scored out of 30, with a higher score indicating better cognitive function, and has two recommended cut-off scores (25 and 21). The higher cut-off score has both high specificity and sensitivity and is at least five times more likely to have come from a dementia patient than without. A score of 21 or less is almost certainly diagnostic of a dementia syndrome regardless of the clinical setting.^[15] It has been found to be superior to the MMSE in diagnostic utility.^[16][17]

References[edit]

1. ^Mioshi, Eneida; Dawson, Kate; Mitchell, Joanna; Arnold, Robert; Hodges, John R. (November 2006). 'The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening'. International Journal of Geriatric Psychiatry. 21 (11): 1078–1085. doi:10.1002/gps.1610. PMID16977673.
2. ^ ^abcMathuranath, P. S.; Nestor, P. J.; Berrios, G. E.; Rakowicz, W.; Hodges, J. R. (12 December 2000). 'A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia'. Neurology. 55 (11): 1613–1620. doi:10.1212/01.wnl.0000434309.85312.19. PMID11113213.
3. ^Hodges, John R.; Larner, Andrew J. (2017). 'Addenbrooke's Cognitive Examinations: ACE, ACE-R, ACE-III, ACEapp, and M-ACE'. Cognitive Screening Instruments. pp. 109–137. doi:10.1007/978-3-319-44775-9_6. ISBN978-3-319-44774-2.
4. ^ ^abFolstein, Marshal F.; Folstein, Susan E.; McHugh, Paul R. (November 1975). 'Mini-mental state'. Journal of Psychiatric Research. 12 (3): 189–198. doi:10.1016/0022-3956(75)90026-6. PMID1202204.
5. ^Parasuraman, Raja; Greenwood, Pamela M.; Haxby, James V.; Grady, Cheryl L. (1992). 'Visuospatial attention in dementia of the Alzheimer type'. Brain. 115 (3): 711–733. doi:10.1093/brain/115.3.711. PMID1628198.
6. ^Mioshi, Eneida; Dawson, Kate; Mitchell, Joanna; Arnold, Robert; Hodges, John R. (November 2006). 'The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening'. International Journal of Geriatric Psychiatry. 21 (11): 1078–1085. doi:10.1002/gps.1610. PMID16977673.
7. ^ ^abcHsieh, Sharpley; Schubert, Samantha; Hoon, Christopher; Mioshi, Eneida; Hodges, John R. (2013). 'Validation of the Addenbrooke's Cognitive Examination III in Frontotemporal Dementia and Alzheimer's Disease'. Dementia and Geriatric Cognitive Disorders. 36 (3–4): 242–250. doi:10.1159/000351671. PMID23949210.
8. ^Noone, Peter (17 July 2015). 'Addenbrooke's Cognitive Examination-III'. Occupational Medicine. 65 (5): 418–420. doi:10.1093/occmed/kqv041. PMID26187808.
9. ^https://www.helpguide.org/articles/alzheimers-dementia-aging/age-related-memory-loss.htm Smith, Melinda; Robinson, Lawrence; Segel, Roberts. (July 2019) . Age-Related Memory loss. HelpGuide.
10. ^Johnson-Laird, P. N. (1 March 1987). 'The mental representation of the meaning of words'. Cognition. 25 (1): 189–211. doi:10.1016/0010-0277(87)90009-6. PMID3581726.
11. ^https://www.neuronup.com/en/areas/functions/visuospatial. Neuron Up. (2012). Visuospatial Skills. Neuron Up.
12. ^Elamin, Marwa; Holloway, Guy; Bak, Thomas H.; Pal, Suvankar (2016). 'The Utility of the Addenbrooke's Cognitive Examination Version Three in Early-Onset Dementia'(PDF). Dementia and Geriatric Cognitive Disorders. 41 (1–2): 9–15. doi:10.1159/000439248. PMID26473749.
13. ^Matias-Guiu, Jordi A.; Cortés-Martínez, Ana; Valles-Salgado, Maria; Rognoni, Teresa; Fernández-Matarrubia, Marta; Moreno-Ramos, Teresa; Matías-Guiu, Jorge (29 September 2016). 'Addenbrooke's cognitive examination III: diagnostic utility for mild cognitive impairment and dementia and correlation with standardized neuropsychological tests'. International Psychogeriatrics. 29 (1): 105–113. doi:10.1017/S1041610216001496. PMID27682860.
14. ^'Dementia test - Brain and Mind Centre'. University of Sydney. 2018-05-30. Retrieved 2018-06-28.
15. ^ ^abHsieh, Sharpley; McGrory, Sarah; Leslie, Felicity; Dawson, Kate; Ahmed, Samrah; Butler, Chris R.; Rowe, James B.; Mioshi, Eneida; Hodges, John R. (2015). 'The Mini-Addenbrooke's Cognitive Examination: A New Assessment Tool for Dementia'. Dementia and Geriatric Cognitive Disorders. 39 (1–2): 1–11. doi:10.1159/000366040. PMC4774042. PMID25227877.
16. ^Larner, A. J. (May 2015). 'Mini-Addenbrooke's Cognitive Examination: a pragmatic diagnostic accuracy study'. International Journal of Geriatric Psychiatry. 30 (5): 547–548. doi:10.1002/gps.4258. PMID25855207.
17. ^Larner, A. J. (October 2015). 'Mini-Addenbrooke's cognitive examination diagnostic accuracy for dementia: reproducibility study'. International Journal of Geriatric Psychiatry. 30 (10): 1103–1104. doi:10.1002/gps.4334. PMID26376107.

External links[edit]

• The ACE-III - test questionnaires and administration guides