Clinimetrics: Towards a diagnostic neuropsychology grounded in Alzheimer's disease.

IF 1.8 4区 心理学 Q2 PSYCHOLOGY
Ciro Rosario Ilardi
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引用次数: 0

Abstract

Neuropsychology's place in diagnosing dementia is still up for debate. With the advent of disease-modifying therapies, the optimisation of diagnostic pathways is increasingly urgent, particularly in the early stages of Alzheimer's disease. Yet, biomarker-driven frameworks eclipse neuropsychological testing as an ancillary tool rather than recognising it as a core component of clinical assessment. Emerging evidence indicates that relying solely on biomarkers does not provide a dependable forecast for the onset or progression of dementia. This drawback underscores how important neuropsychology is. Nonetheless, the clinical adoption of neuropsychological tests for diagnostic purposes requires a paradigm shift towards a more rigorous methodology. Despite its recognised diagnostic potential, the current neuropsychological framework is constrained by thresholds derived from normative distributions rather than Clinimetrics. Many existing tests rely on arbitrary cut-offs that do not account for disease prevalence, personological variability, or real-world cognitive performance. This oversimplified approach reduces the sensitivity of neuropsychological assessments and limits their integration into clinical practice. The development of population-specific clinimetric studies that establish weighted cut-offs for sensitivity and specificity based on clinical aims is crucial to ensure clinically meaningful decision-making.

临床计量学:基于阿尔茨海默病的诊断神经心理学。
神经心理学在诊断痴呆症中的地位仍存在争议。随着疾病修饰疗法的出现,诊断途径的优化日益迫切,特别是在阿尔茨海默病的早期阶段。然而,生物标志物驱动的框架取代了神经心理学测试作为辅助工具,而不是将其视为临床评估的核心组成部分。新出现的证据表明,仅仅依靠生物标志物并不能为痴呆症的发生或进展提供可靠的预测。这一缺陷凸显了神经心理学的重要性。尽管如此,临床采用神经心理学测试诊断的目的需要一个范式的转变,以更严格的方法。尽管其公认的诊断潜力,目前的神经心理学框架受到来自规范分布的阈值的限制,而不是临床指标。许多现有的测试依赖于任意的截止值,这些截止值不能解释疾病的患病率、人格变异或现实世界的认知表现。这种过于简化的方法降低了神经心理学评估的敏感性,限制了它们与临床实践的结合。发展针对人群的临床计量学研究,根据临床目标建立敏感性和特异性的加权截止值,对于确保有临床意义的决策至关重要。
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来源期刊
Journal of Neuropsychology
Journal of Neuropsychology 医学-心理学
CiteScore
4.50
自引率
4.50%
发文量
34
审稿时长
>12 weeks
期刊介绍: The Journal of Neuropsychology publishes original contributions to scientific knowledge in neuropsychology including: • clinical and research studies with neurological, psychiatric and psychological patient populations in all age groups • behavioural or pharmacological treatment regimes • cognitive experimentation and neuroimaging • multidisciplinary approach embracing areas such as developmental psychology, neurology, psychiatry, physiology, endocrinology, pharmacology and imaging science The following types of paper are invited: • papers reporting original empirical investigations • theoretical papers; provided that these are sufficiently related to empirical data • review articles, which need not be exhaustive, but which should give an interpretation of the state of research in a given field and, where appropriate, identify its clinical implications • brief reports and comments • case reports • fast-track papers (included in the issue following acceptation) reaction and rebuttals (short reactions to publications in JNP followed by an invited rebuttal of the original authors) • special issues.
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