Neuropsychological assessment: sense and sensibility.

See related article, pages ●●●–●●●. R esearch on vascular factors in dementia and vascular cognitive impairment has gone through some major developments the past decades. Until 1993, the term multi-infarct dementia was used to distinguish dementia caused by one or more infarctions from Alzheimer disease. 1 Research on cognitive functioning aimed at obvious cognitive impairment after a stroke, that was generally quantified with dementia screening methods. In 1993, the first set of diagnostic criteria of vascular dementia was introduced, which led to an expansion in the number of publications on the subject. 2 In these criteria, several vascular mechanisms, pathology, and circumscript lesions or localizations were defined that may lead to vascular dementia. As the field evolved, new insights arose, accompanied with the acknowledgment that not all cognitive decline fulfilled the criteria of dementia. The concept of vascular cognitive impairment was formulated as an umbrella term that encompasses all cognitive deficits associated with vascular factors or mechanisms. 3 Meanwhile, several attempts have been made to further differentiate specific patterns of cognitive impairment related to distinct vascular pathology. Efforts have been made with regard to poststroke dementia 4,5 and subcortical vascular ischemic dementia. 6 Still, the number of publications on cognitive deficits related to vascular factors is growing, and presently several studies aim to objectify even more subtle cognitive changes. In this issue of Stroke, for instance, Gunstad et al present data on neuropsychological test results in older adults with cardiovascular disease in relation to SELP 1087 G/A poly-morphism and conclude that contrary to their expectations, based on the findings in one other study, patients with SELP 1087A allele performed more poorly on neuropsychological testing. The authors state that there were differences on " multiple tests in the attention/executive function/psychomo-tor speed domain " and on a memory index. However, they let the opportunity slip to put the results in perspective by placing them in a psychometric profile nor do they provide a possible explanation for their findings. Although Gunstad et al recognize the limitations of their study and suggest further research on the topic, they scarcely discuss the advantages and/or limitations of the neuropsychological methods used, which in itself might provide clues in understanding the data. A well-performed neuropsychological examination provides a reliable method to quantify cognitive functioning, and some studies even state that a neuropsychological assessment may have a better predictive value in (preclinical) dementia than imaging techniques. 7 An …