Neuropsychological tests

Peggygh

I was diagnosed with Alzheimer's 5 months ago. I had been complaining on and off for 4 years that I was forgetful and having trouble with finding my words. I was given an MRI (2021) which shown a right lacuna infarction and mild chronic small vessel disease ( Neurologist said it was nothing to worry about). He then proceeded to diagnose me with ADD. Revisited Neurologist again in March ('25) because I felt I had gotten worse and was given an Amaloyd Petscan which was positive for Alzheimer's. An EEG was normal. Found a new Neurologist. He ordered Neuropsychological testing. My Results showed Generalized Anxiety Disorder, Panic Disorder, Mild Depression. I scored Average with normal Cognitive issues that he believes is caused by my anxiety and normal aging and not Alzheimer's although he says I'm at a risk for it , I am 71. However, he does suggest that I should follow up with Additional tests. Would appreciate any thoughts! How accurate are these tests?

LBC83

https://alzconnected.org/discussion/73864/neuropsychological-tests

I am not a Doctor and I have no medical training. So, treat this info accordingly 😊

Let me first go through my AD diagnosis process, then discuss your process.

In my annual physical with my Nurse Practitioner in October 2023, I raised a concern about memory issues. She asked several easy questions (“Who is president?” and “Without looking at your watch, approximately what is the current time?”). I could easily answer these questions, so she declared my cognition normal. But I pressed the point, so she referred me to the Lou Ruvo Center for Brain Health at the Cleveland Clinic. In my first visit in January 2024, another Nurse Practitioner administered the Montreal Cognitive Assessment (MoCA for short). This is a 10-minute screening tool testing multiple areas of memory. The MoCA is primarily used to distinguish between normal aging and Mild Cognitive Impairment (MCI). I scored one point below normal. The Nurse Practitioner then ordered numerous lab tests, an MRI, and a detailed neuropsychological test. In the neuropsychological test, I scored very well in some areas, normal in other areas, but low in short term memory. The MRI served several purposes. First, to rule out other possible causes of my memory issues (such as vascular dementia), second to check for any existing abnormalities in my brain (such as small brain bleeding or swelling).

My low memory scores in these tests lead to a choice between a PET scan or a lumbar puncture as confirmation of the biology in the brain associated with Alzheimer’s (i.e., searching for biological evidence of amyloid plaque in the brain, a hallmark of AD). I chose a lumbar puncture, and the results confirmed my AD diagnosis. I then started on Leqembi, one of the newly FDA-approved anti-amyloid drugs.

With this background, you begin by indicating you were diagnosed with AD 5 months ago. You are apparently referring to your Amyloid PET scan results. To repeat, the Amyloid PET scan simply detected the presence of Amyloid plaque in your brain. This is *not* sufficient by itself to diagnose Alzheimer’s Disease, as many people who have Amyloid plaque in their brains do *not* go on to develop Alzheimer’s Disease. The technical term for those with Amyloid in their brains but no short-term memory decline is "preclinical AD."

Then you had Neuropsychological testing. I’m presuming your Neuropsychological testing was similar to mine, lasting several hours with multiple types of tests. While my test results showed deficiencies in short-term memory, your tests apparently did not. This is seemingly a good thing, indicating that you do not have AD. I received a detailed report on the results of my Neuropsychological testing from the Neuropsychologist responsible for the testing (the testing itself was actually conducted by staff members working with the Neuropsychologist). The test results were also forwarded to my Neurologist. You might want to ask for a copy of the report from the Neuropsychologist, it seems you only heard the summary from your Neurologist.

You asked about the accuracy of these cognitive tests. In general, my sense is the detailed Neurological exam you had is considered very accurate at assessing the brain.

At the Alzheimer’s Association International Conference in Toronto, there was a session on this topic, titled “Clinical Practice Guideline on Cognitive Assessments for the Early Detection of Cognitive Impairment in Primary Care.” The guidelines are still under development. They reported at the conference they reviewed ten cognitive tests often used in clinical practices in primary care (as opposed to used by Neuropsychologists): 5-Cog, AD8, GPCOG, IQCODE, Mini-Cog, MIS, MoCA, QDRS, RUDAS, and SLUMS. They reviewed 41 studies with results from these tests. There was much discussion in the room amongst the Primary Care Doctors in attendance about the pros/cons of the various tests (i.e. whether they were easily accessible via the Internet, if there was a cost associated with using the test, the accuracy of the test, etc).

I hope some of this is helpful.

Peggygh

https://alzconnected.org/discussion/comment/251472#Comment_251472

https://alzconnected.org/discussion/comment/251472#Comment_251472

Thank you LBC83 for such a detailed Response. You put my mind at ease.

My Neurologist called today and agreed with the Neuropsychologist on his findings. He also said I was still at risk for Alzheimer’s and that I should continue to exercise, eat healthy and to socialize. I should also continue to see the Neurologist so that he can continue to gauge me cognitively.

I really appreciate everyone on this board. God bless each and everyone of you!