Individualized Summary Assessment of Detailed Neuropsychological Testing for the Etiological Diagnosis of Newly Detected Cognitive Impairment in Hospitalized Geriatric Patients

Article type: Research Article

Authors: Mäurer, Anja^a | Himmel, Gudrun^a | Lange, Catharina^b | Mathies, Franziska^c | Apostolova, Ivayla^c | Peters, Oliver^d | Buchert, Ralph^{c; *}

Affiliations: [a] Vivantes Ida-Wolff-Krankenhaus, Berlin, Germany | [b] Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany | [c] Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | [d] Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

Correspondence: [*] Correspondence to: Ralph Buchert, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 40 741054347; Fax: +49 40 741040265; E-mail: [email protected]; ORCID: 0000-0002-0945-0724

Abstract: Background:Neuropsychological testing (NPT) of geriatric inpatients can be affected by the acute illness and/or the hospitalization. Objective:To test individualized interpretation of detailed NPT for the differentiation between primary ‘neurodegenerative’ etiologies (predominantly Alzheimer’s disease) and ‘other’ etiologies (including cerebrovascular disease) of newly detected cognitive impairment in geriatric inpatients without and with delirium in remission. Methods:96 geriatric inpatients (81.9±5.6 years, 64.6% females) with clinically uncertain cognitive impairment were included. 31.3% had delirium in remission that was not considered the primary cause of the cognitive impairment. Categorization of the most likely etiology as ‘neurodegenerative’ or ‘other’ was established retrospectively by a study neuropsychologist based on individualized summary assessment of detailed NPT compiled in a standardized vignette. The etiological diagnosis based on FDG-PET served as gold standard (54.2% ‘neurodegenerative’, 45.8% ‘other’). Results:Individualized summary assessment by the study neuropsychologist was correct in 80 patients (83.3%, 8 false positive, 8 false negative). The impact of delirium in remission was not significant (p = 0.237). Individualized summary assessment by an independent neuropsychologist resulted in more false positive cases (n = 22) at the same rate of false negative cases (n = 8). Automatic categorization with a decision tree model based on the most discriminative NPT scores was correct in 68 patients (70.8%, 14 false positive, 14 false negative). Conclusion:Individualized summary assessment of detailed NPT in the context of relevant clinical information might be useful for the etiological diagnosis of newly detected cognitive impairment in hospitalized geriatric patients, also in patients with delirium in remission, but requires task-specific expertise.

Keywords: Alzheimer’s disease, delirium, dementia, etiological diagnosis, hospitalized geriatric patients, neuropsychological testing

DOI: 10.3233/JAD-221273

Journal: Journal of Alzheimer's Disease, vol. 94, no. 2, pp. 559-584, 2023