46 The Neuropsychological Evaluation Provides Incremental Value When Compared to Services Rendered by Other Providers

Abstract

Objective:

Medical providers often express difficulty in detecting dementia (Bradford et al., 2009), feel ill-equipped to address issues related to dementia care, or neglect to communicate dementia diagnoses and treatment recommendations (Alzheimer’s Association, 2015). Despite this, neuropsychologists, who are specifically trained in dementia diagnosis and treatment planning, are not always utilized in the dementia care process. The objective of this study was to investigate family members’ perceptions regarding the incremental benefit of the neuropsychological evaluation, relative to previously rendered services, in addressing patient diagnosis/symptoms and in discussing future care plans.

Participants and Methods:

A survey questionnaire was distributed to family members of patients who had undergone a neuropsychological dementia workup at a university medical center in the Midwest by one of five neuropsychology providers. Immediately following the neuropsychological feedback session, family members were provided a $10 gift card and a stamped, pre-addressed envelope to return the survey anonymously by mail. Respondents were typically spouses (60.6%) or adult children (29.1%), with 82.4% identifying themselves as the primary caregiver. Patient age ranged from 52 to 92 years (M=73.4). Sixty-seven percent of patients were diagnosed with dementia and 24% with mild cognitive impairment; 9% were not diagnosed with a cognitive disorder. The most commonly suspected etiology for cognitive impairment was Alzheimer’s disease or mixed Alzheimer’s and vascular disease (46%). Providers noted as previously having been involved in the care of the patients’ cognitive symptoms included primary care providers (88%), neurologists (60%), psychiatrists (13%), and psychologists (9%).

Results:

Two-hundred surveys were disseminated with a response rate of 64% (n=127). Family members were asked to compare the benefit of the neuropsychological evaluation in addressing the patients’ symptoms as compared with services rendered by previous providers using a Likert scale ranging from 1 (not beneficial) to 5 (extremely beneficial). The average benefit rating was 4.6/5.0 (SD=0.7) for the neuropsychological evaluation as compared with 3.0/5.0 (SD=1.1) for previous services, a statistically significant difference (p <.001). Family members were also asked to rate the helpfulness of both the neuropsychologist and previous providers in discussing aspects of the patient’s diagnosis and care plan using a Likert scale ranging from 1 (not helpful) to 5 (extremely helpful). Comparison using Wilcoxon signed-rank tests indicated neuropsychologists were rated as significantly more helpful than previous providers (p < .001) in discussing the cause or diagnosis for their family member’s symptoms (M=4.6/5.0 vs. M=3.0/5.0), strategies for providing care to their family members (M=4.5/5.0 vs. M=2.8/5.0), a comprehensive treatment and care plan (M=4.3/5.0 vs. M=2.6/5.0), symptom impact on activities of daily living (M=4.4/5.0 vs. M=2.9/5.0), and symptom impact on current and future functioning (M=4.4/5.0 vs. M=2.8/5.0).

Conclusions:

Overall, family members reported the neuropsychological evaluation and feedback session to be significantly more helpful in addressing patient cognitive diagnoses, symptoms, and care plan as compared to previously rendered services by non-neuropsychologists. The results underscore the unique and incremental benefit of the neuropsychological evaluation, not only in diagnosis, but also in assisting family in understanding symptom nature, functional impact, and resultant care needs.