The clinical evaluation of neurocognitive disease includes a detailed assessment of cognition
A clinical evaluation of neurocognitive disease includes a detailed assessment of cognition. In this context, false positives may occur due to poor education or low intelligence.
During our evaluation, we must be aware of the possibility of false positives due to poor education or low intelligence. It is important to assess how well individuals follow instructions, respond to auditory and visual stimuli, and respond to spoken language.
Lately there has been a push for early detection and intervention of neurocognitive diseases. With better understanding of neurocognitive disease comes the concern for false positives and negatives linked to neurocognitive deficits. For example, individuals who are of lower education level or who have lower intelligence scores may score worse on neuro cognition tests than others, resulting in incorrect diagnosis of neurocognitive disease.
Assessment of neurocognitive function often includes evaluation of general intellectual ability, verbal and visual memory, language comprehension, and executive functioning (e.g., planning, organization, abstract thinking). Poor performance on neuropsychological testing may result from premorbid levels of intelligence or cerebral reserve (e.g., education), rather than a specific damage to cognition.
Cognitive testing is a valuable tool for assessing the cognitive functions of patients with neurologic disease. There are multiple methods of evaluating cognition, and it is important to be familiar with each type. Recording subject responses during testing as well as other physiological measures can generate a more complete picture.
While education and intelligence can impact how a patient responds to cognitive testing, the clinician should be cautious not to falsely assume the presence of disease based on commonly acquired conditions that result in a similar, but not clinically significant, deterioration in skills. Rather than adjusting the actual tests administered, educators should focus more on educating patients about the importance of self-appraisal and healthy lifestyle choices that may help offset cognitive decline associated with aging or other more benign etiologies.
false positives can be caused by persons with an average or above average IQ having higher completion rates of the test due to better attention to detail, fewer distractions, and a desire to please the examiner. While this factor is not common in educated patients it can present in less educated persons who are not accustomed to providing standardized responses.
Neurologic examination is a systematic structured way of evaluating all neurological function. In clinical practice it is used to assess a patient’s cognitive ability which is assessed by taking the mental status examination. A valid assessment of cognition should take into consideration the patient’s formal educational level, general intelligence and premorbid levels of functioning.
Time limitations on neuropsychological testing The cultural background of the patient The quality of the educational system The skills and techniques used to administer neuropsychological tests
Presenting all symptoms, or signs, may result in a false positive. This is due to the fact that some symptoms can be misinterpreted.
The clinical evaluation of neurocognitive disease includes a detailed assessment of cognition. Which of the following aspects of cognitive testing may result in false positives due to poor education or low intelligence?