The ecological validity of the Uniform Data Set 3.0 neuropsychological battery in individuals with mild cognitive impairment and dementia

How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores

“…Results replicate prior findings, which suggested Trail Making Part B is one of the more difficult to complete tests for cognitively compromised individuals (Kiselica & Benge, 2019; Wong et al., 2016). In fact, the inability to complete Trail Making Part B was a strong predictor in its own right of increasing dependence in day to day functioning in recent analyses (Benge et al., 2020).…”

“…Of course, the inability to complete neuropsychological tests may provide useful information in its own right (Benge et al., 2020; Pastorek et al., 2004), and a minority of individuals with severe dementia will be able to participate meaningfully in testing. Furthermore, our clinical experience suggests that sometimes trying and failing to produce valid responses on simple tasks “hits home” the need for intervention, support, or placement to family members and referring providers, who may not have initially appreciated the severity of cognitive decline.…”

“…Second, per current billing guidelines (APA, 2019a) one should not charge for testing services when “the patient is … unable to participate in a meaningful way in the testing process; or … there is no expectation that the testing would impact the patient’s medical, functional, or behavioural management” (p. 7–8). Third, testability as a clinical construct might have diagnostic and prognostic value in its own right (Benge, Artz, & Kiselica, 2020; Kiselica & Benge, 2019; Pastorek, Hannay, & Contant, 2004). Fourth, testing a person who cannot meaningfully participate places a strain on limited neuropsychological assessment resources, which might be better allocated.…”

“…Additionally, there have been longstanding debates about whether individuals with severe dementia should undergo neuropsychological testing (Boller, Verny, Hugonot‐Diener, & Saxton, 2002), but data to support such decisions are limited. Recent research suggests that a significant minority (12–28%) of older adults are unable to tolerate elements of testing (Benge et al., 2020; Kiselica & Benge, 2019; Wolf, Weeda, Wetzels, de Jonghe, & Koopmans, 2019; Wong et al., 2016). However, no research has explored the prevalence of test futility across an entire neuropsychological battery.…”

Do we all do the same things? Applicability of daily activities at the intersection of demographics.

“…While we are encouraged by these findings, as researchers and psychologists, there was a major element that gave us pause. Many large studies of FAQ derived from the NACC database, our own work included (e.g., Benge et al, 2022; González et al, 2022; Graves et al, 2023), tended to include only cases with all items completed on this instrument. Although missing data occur in any large-scale data collection effort, the FAQ, as originally designed and as implemented by the NACC, codes multiple categories of missing responses.…”