When Should An Older Adult Be Referred To Neuropsychology?

Changes that affect an individuals concentration, memory, language, or event decision-making and problem-solving are not uncommon among older adults. Sometimes these cognitive changes are merely brief, momentary "slips" which can happen to all of us at one point or another, sometimes they reflect normal aging changes, while other times they may be indicative of an underlying clinically significant symptom. For instance, cognitive symptoms can occur if someone is having psychiatric difficulties (e.g., anxiety or depression), substance abuse, medication side-effects, chronic medical conditions, or the result of underlying neurological disorders.

Neuropsychologists can assist various health and medical professionals by providing them with valuable information about an individuals current cognitive function. This is very important as people continue to live longer than ever before. The neuropsychological assessment is an evaluation that involves the integration of multiple sources of information about a patient, including data collected from an interview, collateral information, and an individual's performance on standardized psychometeric measures.

Benefits of early detection for your patients with cognitive concerns

• A better chance of benefiting from treatment.

• More time to plan for the future.

• Lessened anxieties about unknown problems.

• Increased chances of participating in clinical drug trials, helping advance research.

• An opportunity to participate in decisions about care, transportation, living options, financial and legal matters.

• Time to develop a relationship with doctors and care partners.

• Benefit from care and support services, making it easier for them and their family to manage the disease.

Examples of Geriatric Neuropsychology Referral Questions and Requests

• Does this person have cognitive impairment? Please assess the nature and extent of this individual's cognitive difficulties.

• Is there evidence of cognitive decline?

• Does he/she meet criteria for a dementia or major neurocognitive disorder?

• Can the patient's cognitive symptoms be explained by a condition or disease?

• Is the patient's presentation most consistent with a depression (pseudodementia) or a cortical dementia?

• Is testing suggestive of a specific dementia (e.g., Alzheimer's, vascular, lewy body, FTD, PPA, etc.)?

• The patient has a diagnosis of "X" (or they are undergoing surgery for "X") and a baseline evaluation of their cognitive and emotional functioning would be appreciated.

• Has this individual's cognitive abilities improved, remained stable, or declined since their previous assessment?

• Neuropsychologists can assist various health and medical professionals by providing them with valuable information about an individuals current cognitive function. This is very important as people continue to live longer than ever before. The neuropsychological assessment is an evaluation that involves the integration of multiple sources of information about a patient, including data collected from an interview, collateral information, and an individual's performance on standardized psychometric measures.

Helpful information to include when referring to a neuropsychologist

• Demographic data (e.g., age, gender, education).

• Information about an individual's language preference and whether an interpreter might be required.

• Problems with uncorrected vision or hearing, motor limitations, or pain/fatigue that might pose a challenge to the assessment process.

• Relevant development, medical, and psychiatric history, including knowledge of any conditions or medications that might affect cognition, mood, or behavior.

• Documentation of recent relevant concerns that have lead to being referred for testing.

• A specific referral question.

Neuropsychological testing is recommended for the assessment and diagnosis of cognitive impairment and dementia in older adults. Practice guidelines have been supportive of neuropsychological testing in this population to identify mild cognitive impairment and to differentiate be­tween types of dementia. Physicians often have easy access to a number of brief in-clinic and bedside screening tools like the Montreal Cognitive Assessment (MOCA) and the Mini-Mental State Exam (MMSE). However, these measures are too brief to distinguish between subtle forms or early stages of cognitive decline. More in-depth neuro­psycho­logical assessments can provide a fuller picture of the individuals neurocognitive strengths and weaknesses as well as help differentiate or rule-out various diagnoses. The standardized administration of cognitive tests and the individualized interpretation of results can reveal much about brain-behavior relationships and brain function. A neuropsychological consultation can help characterize their cognitive deficits, clarify diagnoses, and develop optimal management plans for patients with cognitive issues and care for their patient's.