14) The optimal application of NP testing is in conjunction with a good history, physical exam, and knowledge of the differential diagnosis of an elevated NP value.
In non-acute settings, the types of patients who would most benefit from NP testing include patients with symptoms of dyspnea, patients with known coronary artery disease, patients with diabetes, patients with hypertension, and patients older than 60 years of age (8,16-18) (Figure 2)
The study performed by Januzzi et al concluded that the ideal application of NP testing should be used in conjunction with
Because cognitive recovery often lags behind symptom resolution, NP testing may identify subtle brain deficits even in athletes who are asymptomatic at rest or with exercise.
While NP testing may provide additional prognostic information, it should not alter the management of athletes who are symptomatic either at rest or with exercise.
Everyone had extensive NP testing
with standard tests and psychiatric interviews to assess people for depression and other mental illnesses.
Another way in which early NP testing may be beneficial is in disease-course monitoring.
Despite the numerous benefits of NP assessment, it remains impractical to recommend NP testing for all MS patients.
The NP test results may be factored into deciding on return to play, although it has not been conclusively demonstrated that NP testing, used in isolation, is an appropriate way to decide when an athlete is safe to return to competition.
The latest computerized NP testing software packages enable one to do baseline testing on large groups in an efficient manner.
Shoemaker and Hudnell (1) did not obtain NP testing on their subjects, although this represents the current "gold standard" for verifying PEAS; thus, this is a major shortcoming in their work.
The health departments can facilitate the full evaluation of these cases, including NP testing through state health agencies.