McClintock Shawn M, Minto Lex, Denney David A, Bailey K Chase, Cullum C Munro, Dotson Vonetta M
Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA.
Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
Curr Psychiatry Rep. 2021 Jul 13;23(9):55. doi: 10.1007/s11920-021-01267-3.
Older adults with major depressive disorder are particularly vulnerable to MDD-associated adverse cognitive effects including slowed processing speed, decreased attention, and executive dysfunction. The purpose of this review is to describe the approach to a clinical neuropsychological evaluation in older adults with MDD. Specifically, this review compares and contrasts neurocognitive screening and clinical neuropsychological evaluation procedures and details the multiple components of the clinical neuropsychological evaluation.
Research has shown that neurocognitive screening serves a useful purpose to provide an acute and rapid assessment of global cognitive function; however, it has limited sensitivity and specificity. The clinical neuropsychological evaluation process is multifaceted and encompasses a review of available medical records, neurobehavioral status and diagnostic interview, comprehensive cognitive and clinical assessment, examination of inclusion and diversity factors as well as symptom and performance validity, and therapeutic feedback. As such, the evaluation provides invaluable information on multiple cognitive functions, establishes brain and behavior relationships, clarifies neuropsychiatric diagnoses, and can inform the etiology of cognitive impairment. Clinical neuropsychological evaluation plays a unique and critical role in integrated healthcare for older adults with MDD. Indeed, the evaluation can serve as a nexus to synthesize information across healthcare providers in order to maximize measurement-based care that can optimize personalized medicine and overall health outcomes.
患有重度抑郁症的老年人尤其容易受到与抑郁症相关的不良认知影响，包括处理速度减慢、注意力下降和执行功能障碍。本综述的目的是描述对患有重度抑郁症的老年人进行临床神经心理学评估的方法。具体而言，本综述比较并对比了神经认知筛查和临床神经心理学评估程序，并详细介绍了临床神经心理学评估的多个组成部分。
研究表明，神经认知筛查对于提供对整体认知功能的快速评估具有重要作用；然而，其敏感性和特异性有限。临床神经心理学评估过程是多方面的，包括对现有病历的审查、神经行为状态和诊断访谈、全面的认知和临床评估、对纳入和多样性因素以及症状和表现效度的检查，以及治疗反馈。因此，该评估提供了关于多种认知功能的宝贵信息，建立了大脑与行为的关系，明确了神经精神诊断，并可为认知障碍的病因提供依据。临床神经心理学评估在患有重度抑郁症的老年人的综合医疗保健中发挥着独特而关键的作用。事实上，该评估可以作为一个纽带，综合各医疗保健提供者的信息，以最大限度地实现基于测量的护理，从而优化个性化医疗和整体健康结果。
