Part 3: Neuropsychological Evaluation in Clinical Practice: Overview and Approach

Lynn W. Shaughnessy, MA, Maureen K. O’Connor, PsyD, ABCN, and Janet C. Sherman, PhD

Ms. Shaughnessy is a student, Massachusetts School of Professional Psychology, West Roxbury, MA. Dr. O’Connor is an instructor, Department of Neurosurgery, Boston University School of Medicine, Boston, MA, and Director of Neuropsychology, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA. Dr. Sherman is an assistant professor, Department of Neurology, Harvard Medical School, and clinical director, Psychology Assessment Center, Massachusetts General Hospital, Boston, MA.

Question 2

A 65-year-old man presents with “short-term memory loss” and a change in personality reported by his wife. Specifically, his wife reports that he had a temper in the past, but within the past 2 years he has become more irritable and tends to “blurt things out” without regard for others’ feelings. She also reports that he has diminished interest in people and activities that he previously found enjoyable. Neuropsychological testing in conjunction with neurologic evaluation and neuroimaging indicate a behavioral variant of frontotemporal dementia (FTD) as the most likely etiology. Which of the following patterns of neuropsychological evaluation findings is consistent with this etiology?

  •  Clinical observations of diminished awareness and insight into
    difficulties and test findings that indicate deficits on measures
    that require initiation of behavior (on fluency measures), problem
    solving, shifting of behavior, and inhibitory control; these deficits
    contrast with relatively intact performance on measures of language,
    visuospatial functioning, and memory retention
  •  Difficulties in attention, executive functioning, and visuospatial
    abilities along with the patient’s wife describing variability in
    cognitive functioning during the day and visual hallucinations
  •  Impaired orientation and memory performance characterized by
    deficits in consolidation or storage of information as evidenced by
    impaired delayed recall measures with no benefit from recognition
    paradigms; attention and executive functioning are intact
  •  Impairment in sustained attention that upon further questioning
    in clinical history is described as lifelong, although perhaps
    a bit worse as of late
  •  Slowed processing speed and effortful performance across tasks,
    with significant benefit from additional structure; the patient
    complains of cognitive difficulties and poor performance,
    even when errors are mild, and reports severe symptoms of
    depression and anxiety on mood inventories

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