Case Studies

In this section, we will present case studies in neurocogntive testing. You should first review the report for the patient which can be found in the NCDeval database searching for the Date of Service and then looking for the patient by their initials.

In reading these, keep in mind the principal things common to Dementia of the Alzheimer’s Type (DAT) that are testable. In order of their importance, or validity and reliability in diagnosing DAT, they are:

1. Short-term memory (STM) problems. Cues almost always help significantly, but it they don’t help much then we are probably looking at more advanced DAT.

2. Verbal Fluency tested with naming animals, fruits and vegetables as quickly as possible. The FAS test (naming words beginning with F, A and S) is also used, but it is not as sensitive to DAT and the available measures are less well normed. We have well done norms for two tests; the Semantic Verbal Fluency test and the Word Fluency test which are given the exact same way, but unfortunately the norms often offer different results on the same patient. Have you noticed the difference in comparing the two test charts on pages 2 and 4 of the Report? The Verbal Fluency is used in the computer program derived analyses; however, be alert to differences when one shows normal function vs the other. The Word Fluency test is harsher, and shows compromise more often than Semantic Verbal Fluency which gives patients more of a break.

3. Reasoning and Judgment, which would be #2 if only we had better tests of this. The 10-item test of interpreting difficult and simple proverbs, solving simple problems (time and what to do if confronted with fire in a movie theatre) along with determine similarities among different concepts (e.g., shirt, pants and socks) is used in the NCD. This is G. Elovitz’ test, and could stand some better norms some day when he has time to do this, and it is a bit brief – still it has stood the test of time over thousands of cases and thus has considerable “face validity.” In the test kit, you have the longer and better normed Test of Practical Judgment (TOP-J) which should be considered for use. It is amazing but there just aren’t more tests published, and sometimes used are analogous techniques like solving the Porteous Mazes or analytical thinking tested with the Raven’s Matrices or the Test of Non-Verbal Intelligence, which we have.

4. Word finding, or word naming ability when confronted with a pictured object. Confrontation Naming, as it is called, is typically assessed with the Boston Naming Testing (BNT), and we used a shortened 15-item version called the BNT-Modified from the CERAD battery in the NCDeval. Note that in addition to the words being presented in order of difficulty, half the words are high frequency (House) while half are low frequency (harmonica). Word finding is close to equal with Reasoning and Judgment deficits in predicting DAT, and we have good norms for the BNT-M.

Names and identifying information are changed, of course, to protect patients’ privacy.