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Improving clinical cognitive testing: report of the AAN Behavioral Neurology Section Workgroup
Kirk R Daffner1, Seth A Gale2, A M Barrett2
1From the Center for Brain/Mind Medicine (K.R.D., S.A.G., A.C.P.), Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Kessler Foundation Research Center (A.M.B.), West Orange, NJ; Department of Neurology (B.F.B.), Mayo Clinic, Rochester, MN; Department of Neurology and Center for Cognitive Neuroscience (A.C., H.B.C.), University of Pennsylvania, Philadelphia; Helen Wills Neuroscience Institute (M.D.), University of California, Berkeley; Department of Neurology (G.R.F.), University of Florida College of Medicine, Gainesville; Department of Neurology (D.R.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL; Center for Brain Health (J.J.H.), School of Behavioral & Brain Sciences, University of Texas at Dallas; Department of Neurology (A.J.L.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Neurology and Neurological Sciences (K.J.M.), Stanford Comprehensive Epilepsy Center, Stanford University School of Medicine, CA; Western Institute for Neurodevelopmental Studies and Interventions (K.S.V.), Boulder, CO; and Memory Disorders Program (D.I.K.), UNC Department of Neurology, University of North Carolina at Chapel Hill. kdaffner@partners.org.
Objective:
To evaluate the evidence basis of single-domain cognitive tests frequently used by behavioral neurologists in an effort to improve the quality of clinical cognitive assessment.
Methods:
Behavioral Neurology Section members of the American Academy of Neurology were surveyed about how they conduct clinical cognitive testing, with a particular focus on the Neurobehavioral Status Exam (NBSE). In contrast to general screening cognitive tests, an NBSE consists of tests of individual cognitive domains (e.g., memory or language) that provide a more comprehensive diagnostic assessment. Workgroups for each of 5 cognitive domains (attention, executive function, memory, language, and spatial cognition) conducted evidence-based reviews of frequently used tests. Reviews focused on suitability for office-based clinical practice, including test administration time, accessibility of normative data, disease populations studied, and availability in the public domain.
Results:
Demographic and clinical practice data were obtained from 200 respondents who reported using a wide range of cognitive tests. Based on survey data and ancillary information, between 5 and 15 tests in each cognitive domain were reviewed. Within each domain, several tests are highlighted as being well-suited for an NBSE.
Conclusions:
We identified frequently used single-domain cognitive tests that are suitable for an NBSE to help make informed choices about clinical cognitive assessment. Some frequently used tests have limited normative data or have not been well-studied in common neurologic disorders. Utilizing standardized cognitive tests, particularly those with normative data based on the individual's age and educational level, can enhance the rigor and utility of clinical cognitive assessment.
