Neuropsychological Assessment Anxiety: A Systematic Review

Older adults are the fastest growing population seeking cognitive assessment services, primarily regarding cognitive concerns and capacity to live independently. Neuropsychological assessment can evoke stress/anxiety in patients, and anxiety has been implicated in poor test performance. A review of the literature failed to identify empirical articles dedicated to the impact of a patient's awareness of the purpose and potential implications of a neuropsychological evaluation on test performance. This article systematically reviewed literature regarding anxiety/stress to understand what anxiety domains threaten performance, and identify vulnerable cognitive abilities. Seventy-eight articles were reviewed. Sixty anxiety/stress measures were used and were classified into 7 domains: global, trait, state, social, test, and math anxiety, and stress. There were 149 neuropsychological tests that were used and classified into 13 domains: academic achievement, attention, executive functioning (inhibition/switching and reasoning/fluency), full scale intelligence, language, memory (overall, verbal, and visual), mental status exams, motor, perception, processing speed, verbal comprehension, and working memory. Results revealed that (a) most studies examined healthy adult populations, (b) few studies used clinical samples, and (c) no studies focused on older adults from clinical populations. Of the studies reviewed, nearly 2/3 reported some relationship between test performance and anxiety. Test, social, state, and math anxiety were most often associated with poor test performance. Verbal memory, attention, inhibition, and working memory were most consistently associated with anxiety. Findings highlight the importance of attending to anxiety in older adults referred for neuropsychological evaluation and the need for anxiety assessment measures that are sensitive to aging patients' concerns. Clinical Impact Statement Neuropsychological evaluations of older adults may elicit concern and worry given the potential implications regarding continued autonomy. Findings from this literature review highlight the importance for clinicians to observe and address patient worry about test findings.