Serial neuropsychological assessment refers to assessing a patients neurocognitive and adaptive abilities at different intervals over time. For example, baseline neuropsychological assessment occurs during the first time a patient is neuropsychologically evaluated and establishes a “baseline” of functions. This may occur shortly after a patient had sustained a traumatic brain injury, had undergone neurosurgical resection of a brain tumor, or treatment or rehabilitation following a stroke or other neurological diagnoses (e.g., multiple sclerosis, cerebral aneurysm, neurotoxic disorder, etc.). Baseline neuropsychological assessment may also be instituted prior to the development of symptoms or a specific diagnosis. This is particularly seen in athletes who undergo an assessment prior to the start of the season (e.g., football, hockey, soccer). This type of baseline assessment is also strongly recommended in individuals who are reporting or experiencing subtle changes in cognitive efficiency (e.g., reduced memory, transient confusion, personality changes). This might occur in individuals who are experiencing the early signs or symptoms of mild cognitive impairment (MCI).
In essence, serial neuropsychological assessment is paramount for the monitoring of possible neurocognitive and behavioral changes over time. This often occurs at 6-12 month intervals. This is particularly beneficial in identifying an individual’s strengths and weaknesses, treatment efficacy, including rehabilitation treatment modalities, medication, or psychotherapeutic strategies. In part, this compares to an individual undergoing annual bloodwork, having periodic medical checkups, or even going to the dental hygienist. All of these examples for serial testing and medical follow up should enhance the understanding of the patient’s needs, concerns, as well as implementing timely recommendations and interventions which may result in a more favorable outcome and overall prognosis.
CASE STUDY EXAMPLE
A 60-year-old female with 18 years of formal education reportedly was experiencing a gradual progressive decline of memory functions over the course of a few years. Initially, she had undergone a cerebral MRI which identified probable microvascular cerebrovascular disease. She was being followed medically per her primary care physician and neurologist. She was referred for baseline neuropsychological evaluation which suggested a reduction in cognitive efficiency and adaptive abilities. This appeared to be neurologically mediated as opposed to the questionable history of ADHD or exacerbation of post-traumatic stress (PTS). Primary deficits were in general memory and executive dysfunction. It was recommended that she continue to be followed medically and return in one year for follow up neuropsychological assessment.
As recommended above, serial and repeat neuropsychological assessment was completed one year later. She denied interval adaptive changes. However, her husband indicated that she was experiencing “more memory issues” despite utilizing compensatory strategies (e.g., daily routine of activities). Neuropsychological test results demonstrated some neurocognitive deterioration over the past year. This was particularly true in areas of general memory, verbal fluency, information processing speed, sustained levels of attention/concentration, and executive functions. Her general intellectual abilities were essentially unchanged (e.g., average range but below premorbid expectations). Overall, the patient appeared less cognitively efficient than she was a year ago despite utilizing and implementing compensatory cognitive strategies. The patient met the diagnostic criteria for mild cognitive impairment (MCI) which is known to be a precursor toward a possible progressive dementia. At this juncture, it was once again recommended that she undergo repeat neuropsychological assessment in one year.
The above noted case study example reflects the importance of serial neuropsychological assessment.
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Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
Licensed Psychologist #35S100252900