124. Neuropsychological Assessment

Question 1

Psychometric Theory

- what is pathology?

Answer 1

• tests normed on brain-healthy, representative samples
• bell curve: central tendency with spread (mean and std)
• obtained scores referenced against normative data
• adjusted for pt demographics
• pathology = deviation from normative sample mean
• +/-1.3std of mean = 9-90% percentile (normal)

Question 2

What are the 5 steps of a full neuropsychological exam?

Answer 2

1. Diagnostic Interview (1-2hrs)
2. Test Administration (2-4hrs)
3. Data Processing (1-2hrs)
4. Data Interpretation Reporting (2-3hrs)
5. Feedback with Patient (1hr)

total 7-12hrs and EXPENSIVE (2,100-3105$$)

Question 3

Difference between premorbid and current intelligence

Answer 3

Premorbid: estimate ability prior to sx onset to see if decline is significant within individual
- test with Word Reading Ability - well-correlated with IQ even in brain damaged state

Current Intelligence: generalized intelligence estimated by tests targeting 7 domains
Wechsler Intelligence Scales - highly sensitive for acute brain injury

Question 4

List the components of Neruopsych exam and their respective brain domain
Attention and Processing Speed
Executive Function
Anterograde Memory (Encoding, Retention)
Visuospatial
Motor
Personality/Psychopathology

Answer 4

Attention/Processing Speed: Cerebellum, BG, PFC, Parietal Lobe
Executive Function (Planning): PFC
Language: dominant perisylvian fissure
Anterograde Memory: Mesial Temporal Lobe (Retention) and PFC (encoding)
Visuospatial (Dorsal, Ventral Streams)
Motor Function: motor cortex, premotor cortex
Personality/Psychopathology: Empiric (groups of patients) and Thoeretically Derived (theoretical descriptions)

Question 5

What are the indications for neuropsychological assessment?

Answer 5

• Specific decision-making capacities
• Suspected Dementia
• Cognitive Sequelae of TBI
• Suspected Developmental Disorder (ID, LD, ADHD)
• Pre/Post Tx Baseline (Neurosurgery, Organ tx)
• Sequelae of conditions that affect condition

NOT: fluctuating delirium, uncooperative pt, reversible AMS, verbal limitations, acute sx needed inpatient tx