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 recognitionparadigms; 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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