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Klinische Neurophysiologie 2017; 48(04): 200-210
DOI: 10.1055/s-0043-118778
Review
© Georg Thieme Verlag KG Stuttgart · New York

Neuropsychologische Diagnostik in der Praxis. Was ist leitliniengerecht, was ist sinnvoll, was ist machbar?

Neuropsychological assessment in Clinical Practice: What is Feasible and What is Suitable?
Andreas Johnen
1   Klinik für Allgemeine Neurologie, Universitätsklinikum Münster
,
Thomas Duning
1   Klinik für Allgemeine Neurologie, Universitätsklinikum Münster
› Author Affiliations
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Publication History

Publication Date:
25 October 2017 (online)

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Zusammenfassung

Richtig angewendet erreicht die neuropsychologische Diagnostik in der neurologischen Praxis eine hohe Sensitivität und Spezifität bei der differentialdiagnostischen Zuordnung alltagsrelevanter kognitiver Defizite. Insbesondere bei primär neurodegenerativen Erkrankungen mit dementiellen Symptomen erlaubt die neuropsychologische Diagnostik bereits in frühen Krankheitsstadien eine korrekte Zuordnung verschiedener Demenzerkrankungen und gehört bei diesen Erkrankungen zu einer leitliniengerechten Diagnostik. Inzwischen wird der neuropsychologischen Diagnostik jedoch auch bei anderen Erkrankungen, z. B. entzündlichen ZNS-Erkrankungen, ein großer Stellenwert eingeräumt, insbesondere mit Blick auf neue therapeutische Optionen. Neben einer ausführlichen neuropsychologischen Untersuchung können auch Kurztests – wenn sie richtig und zielgerichtet eingesetzt werden – entscheidende diagnostische Hinweise geben. Trotz dieser Vorteile hat die neuropsychologische Diagnostik Grenzen und Einschränkungen. Einige dieser Einschränkungen sind vermeidbar, wenn die neuropsychologische Untersuchung zielgerichtet und hypothesengeleitet angewendet und entsprechend richtig interpretiert wird. In dem folgenden Übersichtsartikel geben wir einen Überblick über grundsätzliche Möglichkeiten und vermeidbare Einschränkungen der neuropsychologischen Diagnostik sowie konkrete Hinweise auf anwendbare Tests bei verschiedenen Fragestellungen.

Abstract

When correctly applied, neuropsychological assessment has high sensitivity and specificity in the differential diagnosis of cognitive deficits in clinical practice. Particularly in the case of primary neurodegenerative diseases, neuropsychological assessments allow correct diagnosis of different dementia syndromes in early stages of the disease and are essential to a guideline-based diagnosis. Additionally, the results of neuropsychological testing are important outcome variables in e. g. inflammatory CNS disorders, particularly with regard to therapeutic options. If targeted and performed correctly, short neuropsychological screening tests can provide valid diagnostic clues. Despite these advantages, neuropsychological evaluation has diagnostic constraints and limitations. Some of these limitations are avoidable if the neuropsychological examination is targeted, guided by a clinical hypothesis, and interpreted correctly. Here we provide an overview of basic prospects and avoidable limitations of neuropsychological diagnostics, as well as practical references to applicable tests for various questions.

Schlüsselwörter

Neuropsychologie - Diagnostik - Kognitive Störungen - Demenzen - Neuropsychologische Tests

Key words

neuropsychology - diagnostics - cognitive impairment - dementia - neuropsychological tests
 

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