2004, Number 3
La evaluación neuropsicológica del anciano
Galindo CVMG, Balderas CE
Full text
Language: Spanish
References: 22
Page: 9-18
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ABSTRACT
This article presents a general panorama of the theoretical framework underlying the clinical neuropsychological assessment practice involving elderly patients. Also, it describes a series of techniques, strategies and tests commonly used in the neuropsychological diagnosis of this population, indicating their capacities and limitations. Throughout the text, the authors mention the characteristics of a neuropsychological study and the challenges to be dealt with in the clinical work with patients.Through this article, the authors try to demonstrate that daily neuropsychological practice demands knowledge, flexibility, curiosity and creativity, because the neuropsychologist has the promise that, even in routine situation, he/she will constantly gain insight into the functioning of the brain, as well as the best strategies for evaluating the patient according to his/hers individual characteristics.
In the mental health field, the neuropsychological evaluation plays an important role not only in the semiology of the neurological symptoms in contrast to psychiatric ones, but also in identifying neurological upheavals in non-psychiatric patients; in documenting the cognitive status of the patient in the different neurological conditions, and in identifying and locating zones of functional commitment that sometimes escape conventional clinical records.
The neuropsychological assessment is useful too when studying diseases that in their initial stages do not modify the anatomy of the brain, such as toxic encephalopaties and dementias.
Also, the authors provide evidence to support that systematized neuropsychological exploration renders information of the functional state of the brain. So, theoretical principles and basic concepts sustaining the clinical practice of the neuropsychologist are described, starting from the fact that the direct observation of the functioning of the brain as a whole in live people is not currently possible. Neurocientists base most of their knowledge of the different states the brain adopts while functioning on methods of indirect observation. The neuropsychological exploration is, in this sense, a systematized method to evaluate cerebral functioning through behavior, its final product.
The neuropsychological observation is based on many common techniques, constructs and theories of psychology. It also implies an intensive study of behavior by means of interviews, tests and questionnaires, that provide relatively reliable and sensible indices of behavior. The distinguishing character between psychology and neuropsychology lies within the conceptual framework of reference, that takes as a departure point cerebral functioning.
As a part of the fundamental theoretical aspects of neuropsychology, the authors analyze the change from the unidimensional concept of organicity to their conception in multidimensional terms, viewed as a phenomenon susceptible of being measured through a systemic approach, weighing the presence of the diverse factors that impact on the behavior of an individual. The concept of behavior, understood mainly in threedimensional terms, is also analyzed and integrated into different components, in order to systematize the cognitive status and the behavior of the patients.
In relation to the neuropsychological evaluation of the elderly, the specific indications are described, such as the diagnosis of dementia versus depression or type of dementia; the measurement of cognitive decline, once the presence and the type of upheaval have been documented; or when the natural history of a suffering is studied to gain insight into its handling for research purposes.
In general terms, a classic pattern of aging in healthy subjects is described, where on one of the extremes dementia is identified as one of the most serious upheavals of the elderly. Circumscribing dementia, the authors dedicate some lines to the topic of memory, given the importance that the study of this function has within the evaluation of aged patients. The components of memory and its theoretical scheme are analyzed from the perspective of clinical evaluation.
The declaratory memory and the memory of procedures are described in detail, in relation to the cortical and subcortical structures that give them biological sustenance, including the different stages.
On the other hand, starting from a conceptual frame, this article provides the clinical neuropsychologist with a methodology to select from the evaluation instruments currently available those that turn out to be the most appropriate to assay each patient. In agreement with the literature, a large amount of instruments are available for such a purpose. In Mexico, most instruments used at present have not been standardized for this population, probably due to the expensive cost of such study. Besides intra- and intercultural differences among groups, the authors discuss various problems neuropsychologists must overcome when evaluating patients in Latin America. These are a consequence of the lack of standardization of the instruments, a fact that gives the qualitative interpretation of the results a crucial role in diagnosis.
This paper also emphasizes the relevance of clinical interviews, both those carried out with the patients, and with their relatives, as a diagnosis tool, in order to delimit the particular reason which prompted the need of an evaluation. The clinical interview provides the physical, mental and psycho-social characteristics of the patient and the type of neurological or psychiatric pathology at issue. Using the interview as a starting point, the clinician designs an evaluation method according to which he/she will have to select the instruments.
Finally, the authors enlist a set of evaluation instruments, among which there are some that have been translated or adapted to Spanish and are currently used in Mexico and other Latin American countries.
REFERENCES