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University of Iowa News Release

March 4, 2004

UI Expert Explains Usefulness Of Memory, Other Cognitive Tests

Increasingly, older adults take cognitive tests to assess possible problems with their abilities to pay attention, learn, remember things and solve problems. Some people are apprehensive about taking the tests or learning the results, but knowing more about the process may help alleviate worries.

It is important to recognize that results from cognitive testing do not provide a definitive prognosis but are assessment and general predictive tools, said a University of Iowa clinical neuropsychologist who administers such tests and studies ways to improve their usefulness. Just as a cardiologist is a specialist who can focus on problems with a person's heart function, a neuropsychologist is a specialist who can focus on a person's cognitive function.

Neuropsychological testing, which includes cognitive tests, helps determine if a person has a psychiatric, neurological or medical condition that contributes to problems with thinking. The results can help identify steps for the person's care.

"Cognitive testing results can provide the patient, their families and their physician information to make decisions that are best for the individual. The testing may help determine if someone with mild dementia still can live independently or if they currently have depression that affects their thinking," said Kevin Duff, Ph.D., assistant professor of psychiatry in the UI Roy J. and Lucille A. Carver College of Medicine.

"The testing gives the most likely probability about what will happen to a person's thinking skills, but the tests are not crystal balls that reveal what the rest of a person's life is going to be like," added Duff, who sees patients through the Neuropsychological Service of UI Hospitals and Clinics.

Most patients come to the UI for testing through physician referrals, after patients report or physicians notice problems with attention, memory or reasoning. The testing, which also is available through the UI Department of Neurology, can assess possible dementia, including Alzheimer's disease, or problems due to stroke, neurodegenerative disease, head injuries or emotional or psychiatric conditions such as depression or bipolar disorder. The adult service also assesses college students who might have attention deficit disorders or learning disabilities that were not apparent in high school.

Neuropsychological evaluations can take two to five hours to complete. An evaluation begins with interviews with the patient and sometimes family members or significant others. The evaluation also reviews the person's medical and psychiatric background as well as education, work history and social background. Experts use the background information to appropriately interpret the test results.

After the interview portions are completed, the cognitive testing begins -- and the main tools are paper and pencil, not tools like MRI or CAT scans that actually provide brain images. Even though a machine is not involved, the test gives the person with a possible cognitive condition a challenge, similar to how a person with a heart condition gets a stress test to pinpoint problems.

"Normally, people may not jog on a treadmill for an extended length of time, but the cardiologist really needs to push them to find out where they are at and what kinds of problems they might be having," Duff said. "In our case, we're stretching a person's cognitive function more than they usually do on a day-to-day basis, so that we can get an accurate picture of what's going on."

Abilities assessed by cognitive testing involve these types of tasks or questions:

*Attention: focusing on two different tasks at the same time
*Language skills: generating an appropriate amount of input or naming objects
*Perceptual abilities: noticing if details are missing from a picture
*Constructual abilities: drawing a one-dimensional object
*Memory: testing how a person takes in and stores information
*Ability to problem-solve: asking "What would you do?" about a commonplace problem
*Emotional functioning: asking about mood, sleep, appetite and energy.

If the results show problem areas, weaknesses or deficits, these may suggest a condition or pattern that experts can diagnose and then make recommendations for treatment or intervention. For example, some people who thought they were in the early stages of Alzheimer's disease find through the testing that they actually have depression, which is treatable and reversible, unlike some dementias.

"Often people are relieved to find out what the likely problem is, although sometimes they are surprised by the cause of the problem," Duff said.

An individual's cognitive function is always interpreted relative to a "normative group" -- people of similar age, education and work background. In addition, test interpretation takes into account the normal aging process, which includes some memory and other cognitive declines.

"We wouldn't want to hold a 75-year-old to the same standard as a 25-year-old, just as we wouldn't want to time an older person in the 50-yard dash and expect them to be as fast as a 25-year-old," Duff said.

Along these lines, Duff studies how to make the tests better. A major focus is to make the normative groups more representative of the general population. In the past, many groups turned out to be based on "supernormals," people with more advanced education and few, if any, medical problems such as heart disease or diabetes.

"Many of the initial normative groups were made up of high-functioning people who did intellectual work for a living and had good health care. They tended to do really well on the tests," Duff explained. "Now we are trying to collect data on individuals who better represent the general population in terms of range of education, medical history, work experience and other background."

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at

STORY SOURCE: University of Iowa Health Science Relations, 5141 Westlawn, Iowa City, Iowa 52242-1178

MEDIA CONTACT: Jennifer Brown, (319) 335-9917 Writer: Becky Soglin.