title: The Diagnostic and Prognostic Value of Neuropsychological Assessment in Memory Clinic Patients.
abstract: Neuropsychological testing has long been embedded in daily clinical practice at memory clinics but the added value of a complete neuropsychological assessment (NPA) to standard clinical evaluation is unknown.
  
  
  
  To evaluate the added diagnostic and prognostic value of NPA to clinical evaluation only in memory clinic patients.
  
  
  
  In 221 memory clinic patients of a prospective cohort study, clinical experts diagnosed clinical syndrome (subjective cognitive impairment (SCI), mild cognitive impairment (MCI), or dementia) and etiology (Alzheimer's disease (AD) or no AD), and provided a prognosis of disease course (decline or no decline) before and after results of NPA were made available. The reference standard was a panel consensus based on all clinical information at baseline and up to 2 follow-up assessments.
  
  
  
  With NPA data available, clinicians changed their initial syndromal diagnosis in 22% of patients, and the etiological diagnosis as well as the prognosis in 15%. This led to an increase in correctly classified cases of 18% for syndromal diagnosis, 5% for etiological diagnosis, and 1% for prognosis. NPA data resulted in the largest improvement in patients initially classified as SCI (syndrome: 93.3% (n = 14) correctly reclassified, etiology: net reclassification improvement [NRI] = 0.61, prognosis: NRI = 0.13) or MCI (syndrome: 89.3% (n = 23) correctly reclassified, etiology: NRI = 0.17, prognosis: NRI = 0.14), while there was no improvement in patients with dementia (syndrome: 100% (n = 1) correctly reclassified, etiology: NRI = -0.05, prognosis: NRI = -0.06). Overall, inclusion of NPA in the diagnostic process increased confidence in all diagnoses with 6-7%.
  
  
  
  Administration of a complete NPA after standard clinical evaluation has added value for diagnosing cognitive syndrome and its underlying etiology in patients regarded as non-demented based on the first clinical impression.
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Willemijn J
authors.initials: WJ
authors.lastname: Jansen
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Ron L H
authors.initials: RL
authors.lastname: Handels
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.|Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: Pieter Jelle
authors.initials: PJ
authors.lastname: Visser
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Aalten
authors.affiliation: Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Bouwman
authors.affiliation: Department of Geriatrics, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Claassen
authors.affiliation: Department of Neurology, Zuyderland Medical Center, Sittard, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van Domburg
authors.affiliation: Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Hoff
authors.affiliation: Department of Geriatrics, Laurentius Hospital, Roermond, The Netherlands.|Department of Geriatrics, St. Jans Gasthuis, Weert, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Hoogmoed
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Albert F G
authors.initials: AF
authors.lastname: Leentjens
authors.affiliation: Department of Geriatrics, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marcel Olde
authors.initials: MO
authors.lastname: Rikkert
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ania M
authors.initials: AM
authors.lastname: Oleksik
authors.affiliation: Department of Geriatrics, Zuyderland Medical Center, Sittard, The Netherlands.
authors.forename: Machiel
authors.initials: M
authors.lastname: Smid
authors.affiliation: Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Claire
authors.initials: C
authors.lastname: Wolfs
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Verhey
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Inez H G B
authors.initials: IH
authors.lastname: Ramakers
mesh_terms: D000544:Alzheimer Disease / Q000150:complications / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D011379:Prognosis
keywords: Alzheimer’s disease; cognitive disorders; consensus; diagnosis; mild cognitive impairment; neuropsychological tests; outpatient clinic; prognosis; reclassification