Normal Cognitive Aging
Cognition includes many component processes, some of which decline during normal aging processes. The idea that our cognitive abilities change with age has support from empirical research. Some cognitive abilities, such as vocabulary, show remarkably little change in the face of normal aging. Other abilities, such as conceptual reasoning, memory, and processing speed, decline gradually over time. That said, there is great diversity among older adults in the rate of decline in some of these abilities. A neuropsychological evaluation provides a comprehensive approach to differentiating normal age-related cognitive changes, with those that can be harbingers of pathological forms of cognitive decline.
Neurodegenerative disease
A neurodegenerative disease is an incurable and debilitating condition that results in the progressive degeneration and eventual death of nerve cells. A neuropsychological evaluation for neurodegenerative disease is designed to identify the extent and severity of an individual’s cognitive and behavioral impairments. An evaluation can also aid with differential diagnosis between different neurodegenerative syndromes.
When a neurodegenerative syndrome has been established, neuropsychological evaluations can provide a baseline as well as longitudinal monitoring of disease progression, including the effects of medication-based or behaviorally-based interventions. In cases where a dementia diagnosis has not yet been established, the evaluation can provide a data-driven approach for the prognosis of dementia. In addition to establishing and differentiating between diagnoses, the cognitive and functional components of a neuropsychological evaluation can provide insight into areas of daily functioning where the patient may need assistance (e.g., remembering appointments, medications, etc.).
Comprehensive characterization of these areas can further guide intervention strategies to adapt to cognitive deficits and preserve independence. Finally, a neuropsychological evaluation can support the determination of a patient’s capacity for independence with respect to medical, financial and legal decision-making.
Dementia vs. mild cognitive impairment
When there is concern that a neurodegenerative process may progress, it is important to characterize the extent and severity of the deficits. One of the important clarifications that a neuropsychological evaluation provides is whether a patient has dementia or mild cognitive impairment (MCI). MCI describes a condition when difficulties with thinking and cognition are greater than what is expected for an individual’s age, but the extent of these changes does not impair functional aspects of daily living responsibilities. Assessment of Activities of Daily Living (ADLs) and Instrumental Activities of Daily living (IADLs) are an important component of a comprehensive neuropsychological evaluation. There are many different kinds of MCI and accurate and systematic evaluation of cognition and function provides more personalized treatment recommendations.