Updated 13 October 2009

Neuropsychological tests enable a clinician to analyze a patient's cognitive status, as well as emotional, psychological, motor, and sensory functions. Such quantitation provides a number of benefits.

First, neuropsychological testing is a relatively sensitive and specific diagnostic tool for AD, and can help distinguish AD from other neurological illnesses. (Technically, a neuropsychological test is required for the clinical diagnosis of the disease.)

Second, testing provides a way to track and document the progression of the disease.

Third, tests allow for the systematic description of the various symptoms that are being experienced by the patient (e.g. suicidal ideation), so that each can be addressed for optimal care.

The field of neuropsychological testing is formidable and beyond the scope of this guide. Our aim here is to provide brief descriptions, references and online resources for a number of the most commonly used neuropsychological tests available for the diagnosis of Alzheimer's disease:

ADAS-Cog (Alzheimer Disease Assessment Scale-Cognitive)
Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD)
Blessed Test
CANTAB - Cambridge Neuropsychological Test Automated Battery
CERAD (The Consortium to Establish a Registry for Alzheimer's Disease) Clinical and Neuropsychological Tests
Clock Draw Test
Cornell Scale for Depression in Dementia (CSDD)
Geriatric Depression Scale (GDS)
Mini-Mental State Exam (MMSE)
Neuropsychiatric Inventory (NPI)
The 7 Minute Screen

ADAS-Cog (Alzheimer Disease Assessment Scale-Cognitive)

• 11-part test that takes 30 minutes and is more thorough than Blessed or MMSE
• Used as a primary outcome measure in many drug trials.
• The best brief exam for the study of language and memory skills.

References:
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry. 1984 Nov;141(11):1356-64. Abstract

Ihl R, Brinkmeyer J, Janner M, Kerdar MS. A comparison of ADAS and EEG in the discrimination of patients with dementia of the Alzheimer type from healthy controls. Neuropsychobiology. 2000 Jan;41(2):102-7. Abstract

Weyer G, Erzigkeit H, Kanowski S, Ihl R, Hadler D. Alzheimer's Disease Assessment Scale: reliability and validity in a multicenter clinical trial. Int Psychogeriatr. 1997 Jun;9(2):123-38. Abstract

Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD)

• Provides a global rating of non-cognitive symptoms.
• Designed for use in assessing the efficacy of prospective clinical drugs.

Reference:
Reisberg B, Borenstein J, Salob SP, Ferris SH, Franssen E, Georgotas A. Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. J Clin Psychiatry. 1987 May;48 Suppl:9-15. Abstract

Blessed Test

• Another quick (~10 minute) test of cognition.
• Assesses activities of daily living and memory/concentration/orientation.

Reference:
Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry. 1968 Jul;114(512):797-811. Abstract

CANTAB - Cambridge Neuropsychological Test Automated Battery

CANTAB is used for the assessment of cognitive deficits in humans with neurodegenerative diseases or brain damage. It consists of thirteen interrelated computerized tests of memory, attention, and executive function, administered via a touch sensitive screen from a PC. The tests are language and largely culture free, and have shown to be highly sensitive in the early detection and routine screening of Alzheimer's disease.

References:
Swainson R, Hodges JR, Galton CJ, Semple J, Michael A, Dunn BD, Iddon JL, Robbins TW, Sahakian BJ. Early detection and differential diagnosis of Alzheimer's disease and depression with neuropsychological tasks. Dement Geriatr Cogn Disord. 2001;12:265-280 Abstract

Fray PJ, Robbins TW. CANTAB battery: proposed utility in neurotoxicology. Neurotoxicol Teratol. 1996 Jul-Aug;18(4):499-504. Abstract

Robbins TW, James M, Owen AM, Sahakian BJ, McInnes L, Rabbitt P. Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia. 1994 Sep-Oct;5(5):266-81 Abstract

CERAD (The Consortium to Establish a Registry for Alzheimer's Disease) Clinical and Neuropsychological Tests

• Includes: Verbal fluency test; Boston Naming Test; MMSE; ten-item word recall; constructional praxis; and delayed recall of praxis items.
• Typically takes 20-30 minutes.
• Convenient and effective at assessing and tracking cognitive decline.

To order the CERAD battery, please visit http://cerad.mc.duke.edu/.

References:
Morris JC, Mohs RC, Rogers H, Fillenbaum G, Heyman A. Consortium to establish a registry for Alzheimer's disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease. Psychopharmacol Bull. 1988;24(4):641-52. Abstract

Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology. 1989 Sep;39(9):1159-65. Abstract

Welsh K, Butters N, Hughes J, Mohs R, Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures. Arch Neurol. 1991 Mar;48(3):278-81. Abstract

Clock Draw Test

Best used in combination with other cognitive assessment instruments, the Clock Draw Test is a simple test to assess cognitive or visuospatial impairment. There are slightly different versions of the test. In general, the subject is asked to draw the face of a clock with all the numbers and is then asked to draw the hands to set at a certain time.

Online version of the test is available at:

A Guide to the Diagnosis and Assessment of Alzheimer's Disease by the International Psychogeriatric Association: View Clock Draw Test; more information on the Clock Draw Test (scroll down the page to view).

References:
Sunderland T, Hill JL, Mellow AM, Lawlor BA, Gundersheimer J, Newhouse PA, Grafman JH. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc. 1989 Aug;37(8):725-9. Abstract

Lee H, Swanwick GR, Coen RF, Lawlor BA. Use of the clock drawing task in the diagnosis of mild and very mild Alzheimer's disease. Int Psychogeriatr. 1996 Fall;8(3):469-76. Abstract

Cornell Scale for Depression in Dementia (CSDD)

• A test shown to be sensitive, reliable, and valid for assessing depression in AD.

Reference:
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry. 1988 Feb 1;23(3):271-84. Abstract

Geriatric Depression Scale (GDS)

A depression scale developed specifically for geriatric patients.

Reference:
Burke WJ, Roccaforte WH, Wengel SP. The short form of the Geriatric Depression Scale: a comparison with the 30-item form. J Geriatr Psychiatry Neurol. 1991 Jul-Sep;4(3):173-8. Abstract

Mini-Mental State Exam (MMSE)

The Mini-Mental State Exam, developed in 1975 by Folestein et al, is a brief test of mental status and cognition function. It does not measure other mental phenomena and is therefore not a substitute for a full mental status examination. It is useful in screening for dementia and its scoring system is helpful in following progress over time. The test can be properly administered by clinical or lay personnel with little training but results are to be interpreted cautiously.

View a sample of the Standardized Mini-Mental State Exam (SMMSE)

A Guide to the Diagnosis and Assessment of Alzheimer's Disease by the International Psychogeriatric Association

References:
Folstein MF, Folstein SE, and McHugh PR. "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189-198. Abstract

Cockrell JR, and Folstein MF. Mini-Mental State Examination (MMSE). Psychopharm Bull. 1988;24(4):689-692. Abstract

Neuropsychiatric Inventory (NPI)

• Assesses 12 neuropsychiatric disturbances common in dementia: Delusions, hallucinations, agitation, dysphoria, anxiety, apathy, irritability, euphoria, disinhibition, aberrant motor behavior, night-time behavior disturbances, and eating disturbances.

References:
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994 Dec;44(12):2308-14. Abstract

Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology. 1997 May;48(5 Suppl 6):S10-6. Abstract

The 7 Minute Screen

The 7 Minute Screen is a screening tool to help identify patients who should be evaluated for Alzheimer's disease. The screening tool is highly sensitive to the early signs of AD, using a series of questions to assess different types of intellectual functionality. The test consists of 4 sets of questions that focus on orientation, memory, visuospatial skills and expressive language. It can distinguish between cognitive changes due to the normal aging process and cognitive deficits due to dementia. The 7 Minute Screen may be administered by a nurse practitioner, physician assistant, medical technician or other trained office personnel. The average amount of time required to conduct and score the screen is 7 minutes, 42 seconds, and hence the name "The 7 Minute Screen."

References:
Solomon PR, Pendlebury WW. Recognition of Alzheimer's disease: the 7 Minute Screen. Fam Med. 1998 Apr;30(4):265-71. Abstract

Solomon PR, Hirschoff A, Kelly B, Relin M, Brush M, DeVeaux RD, Pendlebury WW. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease. Arch Neurol. 1998 Mar;55(3):349-55. Abstract