When the composite score and the clinical picture disagree

A recurring case-conference pattern: a composite score in a reassuring range in a patient whose history, collateral report, and examination all point somewhere else. The protocol is explicit that the clinician overrides, documents the override, and proceeds on clinical judgment.

The reverse pattern is more common and more consequential: a concerning composite in a patient with an obvious non-degenerative explanation — untreated sleep apnoea, uncontrolled depression, anticholinergic burden, recent anaesthesia, poor test conditions at home. Unsupervised digital testing is not supervised neuropsychological testing, and the difference matters most here.

The assessment does not diagnose. It flags domains. Formal neuropsychological evaluation, imaging, or biomarker workup is a clinical decision, made by the clinician, on the clinical picture.