Neuropsych Assessment/role in diagnosis

The neuropsychologist assessment was when we received a definitive diagnosis. The PCP reviewed my husband’s MRI and said it reflected normal aging. I told the PCP that I felt it was more than normal aging and without any resistance he referred us to a neurologist. After speaking with my husband for a few minutes the neuro referred us to the neuropsych for a MoCA Blind since the assessment was by phone appointment. At the end of the call we were given the diagnosis of dementia of the ALZ type. At that time, August 2025, he was stage 4. We didn’t request further testing or assessments once we received the diagnosis.
I’m sorry for your need to be “here” but glad you found this community of supportive, caring and knowledgeable people.

At this point in the progression of dementia, the neuropsych exam will yield more information about the type of dementia and how it is impacting her.

In the early days, imaging is more about eliminating things like tumors as a cause than pinpointing specific deficits and informing a definitive diagnosis. Additionally, the neuropsych is useful for teasing out the loss of very subtle skills, like spatial reasoning, needed for certain IADLs like driving and money management. Seeing this on paper can help a caregiver recognize what guardrails are needed and where.

HB

Our Neuropsych testing result prompted a PETAmyloid scan. (They're worth the 4-5 hours and the exhausted LO afterwards. My DW was spent the whole next day afterwards… what the doc found in the neuropsych testing explained a lot.) The Gene test was positive for APOE4, fam history with AD on both sides of the fam, MRI Brain scan was "yer good. [a couple lil blank spots but nothing to think about]" PETAmyloid showed significant amyloid plaques & Neurologist made the Dx EOAD. DW (60 at the time of Dx, now 61). Referred us to USC, barely got started when insurance ended, took for-e-ver to get a referral to UCLA via medi-CAL. Before insurance spat us out, USC found deficits in an EEG, her MOCA was deficient, MRIBrain "mostly good, let's do the PETAmyloid [again]" but w/o insurance USC never did the PET. UCLA looked at everything, her MOCA was much lower than 6 months before at USC. For some obnoxious reason the original PETAmyloid scan that gave the Dx and the neuropsych test report were not in her file and I didn't have a disk with the images. Drove back to UCLA early this morning & they uploaded from the disk, I uploaded the neuropsych report, now waiting on the neuro to make a definitive Dx of EOAD (again… so she can finally get infusion therapy 7+ months later)… Neuro at UCLA left the Dx as Amnetic MCI pending her review of the original PETAmyloid scan. She's pretty sure she agrees with the original Neuro's Dx.

TLDR: basically, that Neuropsych report was the evidentiary catalyst that got to the PETAmyloid scan that produced the Dx of EOAD.

After MCI diagnosis of Dementia-Possibly Vascular by the Neurologist at the VA, my DH had the Neuro-Psychologist test. It showed visuo-spatial difficulties and lack of executive function. The Psychologist's words that the test was "bizarre"… She said under no circumstances should he be driving. I was shocked. I had noticed he was driving very slowly but had no idea it was due to his dementia. She said that if he were to be in an accident, even if it wasn't his fault, we could be sued and lose everything. I sat my DH down and explained what the Psychologist said and the next day he gave me his keys. Never drove again. 18 months later his diagnosis was changed to Alzheimer's-Posterior Cortical Atrophy by the Neurologist. Dementia is more than memory loss. It's executive function:

Executive functions are the higher-level mental processes in the brain that act like an air traffic control system to help you plan, focus, remember instructions, and juggle multiple tasks.

Core Components

• Working memory: The ability to hold, update, and work with information in your mind over short periods.
• Inhibitory control: The self-control needed to resist impulses, ignore distractions, and think before you act.
• Cognitive flexibility: The capacity to switch gears, think outside the box, and adapt when plans change.

Driving is one of the hardest discussions to have with someone with dementia. Dementia impacts safe driving. Your insurance company might not cover an accident leaving you open to getting sued for everything you own. What you described is not safe driving. Please, take the keys for the safety of your husband and everyone else who is near him while he is driving.