Assessment of Cognition Flashcards
Traditional Clinical Psychology Hx
- 1896: 1st clinic at Upenn by
- First half of 20th century focused on _____ assessment; ____ based
- Post-_____: clinical needs increase
- ‘49 ____ model: scientist-practitioner
- ‘73 ____ model: practitioner-scholar
- Lightner Witmer
- Psychological assessment; stats
- WWII
- boulder
- . Vail
What turned the view on traditional clinical psychology? 2
- WWII
2. Brenda Milner’s work on Henry Molaison
Assessment for “neuro” psychological domains (8)
Intelligence Memory Language Attention Executive Processing speed Visuospatial Affect
Goal of Neuropsych eval?
- To objectively quantify (3) changes
- Limits of Imaging and other lab data - can’t assess: (5)
- (EVIDENCE-BASED) cognitive, affective, and behavioral
- Qualitative data for functionality
Individual variance and range of functionality
Quantification of functional capacity
Detailed QoL
Only where and what, NOT the degree of what it may or may NOT mean
Goal of neuropsych is to objectively quantify (EVIDENCE-BASED) cognitive, affective, and behavioral changes after: 6 events
- Developmental
ADHD, LD, autism, Tourette’s - Acute brain insult
CVA, TBI/CHI, encephalitis, aphasias - Neurodegenerative
Dementia umbrella, Tumors, Epilepsy, NeuroAIDS - Pre-post surgical intervention
Wada, DBS, shunt for NPH, ECT, transplant - Psychiatric
Schizophrenia, BPD, depression, GAD - Medico-legal
MVA, SSDI, toxic exposure, falls, law-suits
Malingering, effort
Capacity
Neuropsych is analagouse to:
Analogous to individualized, domain-specific, functional imaging (example: handedness in epilepsy, Wada)
When is neuropsych eval appropriate to order? (2)
Whenever patient and/OR collateral report indicate concerns over:
Memory, intelligence, language, attention, executive skills, processing speed, V/S skills, capacity, affect, Q of memory malingering
Whenever there SHOULD be cognitive deficit but not reported/denied
Assessment of intelligence uses:
- ****Wechsler Adult Intelligence Scale (III/IV): measures intelligence (Full Scale IQ), broken down into 4 factor indices: Perceptual Organization/Perceptual Reasoning, Verbal Comprehension, Processing Speed, and Working Memory. N = 2200.
- Kaufman Brief Intelligence Test, 2nd Edition: an abbreviated measure of overall intelligence (Full Scale IQ), broken down into Verbal IQ and Nonverbal IQ.
- Stanford-Binet Intelligence Scales (V): Similar to WAIS. N = 4800
What is the Wechsler Adult Intelligence Scale (III/IV)
: measures intelligence (Full Scale IQ), broken down into 4 factor indices: Perceptual Organization/Perceptual Reasoning, Verbal Comprehension, Processing Speed, and Working Memory. N = 2200.
Which two tests assess intelligence in children?
*Wechsler Intelligence Scale for Children-IV
Wechsler Preschool and Primary Scale of Intelligence-III
Also St Binet intelligence scale
Note on IQ:
- Flynn Effect:
- g factor:
- Crystalized intelligence:
- Fluid intelligence:
- substantial increase in average scores on intelligence tests all over the world.
- general intelligence.
- “acquisition” intelligence. culturally loaded and biased yet prefered in western world.
- “use” intelligence.
Assesses general achievement: 3
- Wide Range Achievement Test-4th Edition: Education level based achievement test. The Reading subtest is a good measure of premorbid IQ.
- Wechsler Individual Achievement Test-III: More diagnostic power. N = 3000
- Woodcock-Johnson III
Assesses memory: 6
- ***** Wechsler Memory Scale (III/IV): measure of general memory broken down into 5 factor indices, i.e., immediate memory, delayed memory, visual working memory, auditory memory, and visual memory.
- Brief Visuospatial Memory Test-Revised: measure of visual memory via 6 figure stimuli presentation.
- ***** Rey-Osterrieth complex figure test: measure of visual memory via complex figure presentation.
- California Verbal Learning Test-II: measure of verbal memory via list learning (hardest).
- Auditory Verbal Learning Test: measure of verbal memory via list learning (hard).
- Hopkins Verbal Learning Test-Revised: measure of verbal memory via list learning (shorted of the three).
Language assessment (5)
- AmNart Reading: reading test; a decent measure of premorbid IQ.
- Multilingual Aphasia Examination: Seven domain language test.
- Controlled Oral Word Association Test: Phonemic verbal fluency task.
- Category/Semantic Fluency: Semantic verbal fluency task.
- *****Boston Naming Test: assessment of anomia.
Boston naming test assesses:
language — anomia
Assesses attention and executive functioning: 5
- Working Memory Index of the WMS or WAIS
- ***** Trail Making Test A and B: measure of visual scanning and psychomotor speed; measure of mental flexibility.
- **Stroop test: measure of word reading speed, color recognition, and response inhibition.
- ***** Wisconsin Card Sorting Test: measure of novel problem solving and set-shifting ability; orbitofrontal; brodmann 10, 11, & 47.
5***** Iowa Gambling Task: similar to above
What does the Trial making Test A and B assess?
Attention and executive functioning: : measure of visual scanning and psychomotor speed; measure of mental flexibility.
what does the stroop test assess?
attention and executive functioning:
measure of word reading speed, color recognition, and response inhibition.
What does the wisconsin card sorting test assess?
attention and executive functioning
measure of novel problem solving and set-shifting ability; orbitofrontal; brodmann 10, 11, & 47.
Which three tests assess visuospatial skills?
- ** Rey-Osterrieth complex figure test: the Copy subtest section can be used for pure visual construction measure.
- Judgment of Line Orientation: measure of visual judgment of multiple lines.
- Benton Facial Recognition Test: measure of visual recognition of faces.
what does the Rey-Osterrieth complex figure test assess?
visuospatial skills: the Copy subtest section can be used for pure visual construction measure.
4 motor assessment tests
1 Grooved Pegboard: measure of fine motor dexterity.
2 Tapping: measure of finger tapping speed.
3 Grip Strength: measure of bilateral grip strength.
4 Lateral Dominance Exam
personality and mood assessment: 5
- Psychiatric Diagnostic Screening Questionnaire: brief self-report instrument that screens for DSM-IV Axis I disorders.
- ***** Beck Depression Inventory-II: brief self-report instrument that screens for depression.
- Geriatric Depression Inventory: brief self-report instrument that screens for depression in the elderly.
- ***** Minnesota Multiphasic Personality Inventory-2-Restructured Form: assessment of major symptoms of psychopathology, personality characteristics, and behavioral proclivities.
- Personality Assessment Inventory: Multi-scale test of psychological functioning.
Beck Depression Inventory-II assesses:
personality and mood
brief self-report instrument that screens for depression.
Minnesota Multiphasic Personality Inventory-2-Restructured Form:
personality and mood
assessment of major symptoms of psychopathology, personality characteristics, and behavioral proclivities
Neuropsych “screeners” 6
- *** Mini-Mental State Exam
- ** MoCA
- KMAS
4 Repeatable Battery for the Assessment of Neuropsychological Status
5 Cognistat (NCSE)
6 Dementia Rating Scale-2
6 UK neurocognitive screening procotols
UK Stroke Neuropsychological Screen UK Multidisciplinary Concussion Program Screen UK DBS protocol UK Dementia Clinic protocol UK Epilepsy protocol UK Wada protocol
Bell curve: +or- one is what %?
what about 2 standard deviations
3?
34.13% or 68%
95.4%
99%
What is considered “impaired” on the bell curve
bottom 2.2% (5%)
Why is IQ test no good?
because of standard deviations and what is tested.
IQ scores and percentile/meaning: >130 - 120-129 110-119 90-109 80-89 70-79 62-69 51-61 <51
> 98% - very superior 91-97% - superior 75-90 - high average 25-74 - average 9-24 - low average 2-8- borderline impairment (!) 0.6-1.9 - mild impairment (!!) 0.1-0.5 - moderate to severe impairment (!!!) <0.1 Severe impairement (!!!!)
Case: 29 yo familial LH Caucasian F w/ 12 yrs of spec ed 20+ yr Hx of CPS and GTC Seizures localize left temporal Temporalectomy candidate (?!?)
Testing shows current IQ SS = 69 Delayed memory SS = 70 Verbal fluency SS = 84 Boston Naming Test SS = 86 MAE sentence repetition SS = 85 MAE Token test - comprehension SS = 83 WAIS VCI SS = 78 What next?
Wada Wada Wada!
as you can see, Tx can change significantly based on data
Lumping > splitting… except for when it’s not!
WADA uses sodium/barbital and puts one hemisphere asleep while watching what the alternate hemisphere will do. 3 mins of testing window (fluency, naming, repetition, comprehension, check recall after for memory bilaterally)
72 yo RH Caucasian F w/ 18 yrs of ed w/ fam Hx of AD
Reports anxiety over fam Hx
No direct or collateral Hx of cog decline, ADL’s fine
Testing shows premorbid estimate IQ of 112 (high ave)
Current IQ SS = 108 (average, SEM = 2.12)
Delayed memory SS = 97 (average, SEM = 3.35)
Is there a decline?
Differentials?
Memory SS SEM = 3.35 95% CI, Memory SS = 97 will fall b/t 90 and 104 Is there a decline in memory? Compared to FSIQ = 108? Does having great IQ mean great memory?
Sorry! Not necessarily!
Why not?
Regression to the mean! (Regress 108 to the mean)
72 yo RH Caucasian F w/ 18 yrs of ed w/ fam Hx of AD
Reports anxiety over fam Hx
No direct or collateral Hx of cog decline, ADL’s fine
Within normal limits psychometric scores for cognition
Beck Anxiety Inventory = significant elevation
Geriatric Depression Inventory = significant elevation
Differentials now?
Any Psychiatric concerns?
Self-report, Collateral-report, & appearance of high functioning = can ALL be
deceptive!!!
need to pay attention to attention, psychomotor speed and executive/mental flexibility
Serial data = useful for appropriate treatment planning, triage, referral (PT, OT, Speech, PM&R, psych, etc.), & community reintegration .
