Case 10 - neuropsychological assessment Flashcards
what is neuropsychology
study of the relationship between the brain and the mind
what is clinical neurpsyhcology
evaluation (assessment), rehabilitation, treatment of cognitive and neuro-behavioural deficits
what does a neuropsychological assessment assess
objectively assess cognitive function and mental status
diagnostic clarification and grading of cognitive disorders
who is a neuropsychological assessment used in
children who are not achieving appropriate developmental milestones
stroke victims
patients with head injuries
what does a neuropsychological assessment involve
01: basic neurological examination (EEG, GCS). Only if applicable.
02: interviews, history taking (personal factors, social skills, mood)
03: assessment of cognitive functions using standardised measures
which is the main part of this assessment
the 3rd level
what Is the third level
core component: testing a range of cognitive abilities/deficits (that are known to be linked to brain structures and pathways)
examiner is usually a clinical neurpsyhcologist
what is the assessment assessing in the Brian
attention and concentration
Verbal intellectual skills
Visuospatial/non-verbal reasoning and problem solving
Working memory and mental flexibility
Auditory memory
Visual memory
Language
Processing speed
Executive function
Mood and anxiety/stress
test score validity
how long does the test take
up to 9 to 12 hours
why do we conduct neuropsychological assessments
diagnosis of disorder
Assess impairments to particular skills/behaviours as well as functions that are spared
An apparent memory deficit might actually be a sensory-perceptual problem, an attention deficit, or due to anxiety
Identifying treatment needs
Measure changes over time
Treatment/management of condition driven by accurate picture of symptoms
Customised treatment/rehabilitation programme
Better decision making
Offering advice to the patient
Medico-legal
Used as evidence in: legal claim or criminal investigation
Evaluating competency
Identifying malingering
Research
Research into brain function
Impacts of cognitive deficits on everyday functioning
Evaluating the efficacy/effects of interventions
Identify brain damage
Neuro-imaging all s more precise mapping of structure and function
But neuropsychological assessment can be sensitive to subtle forms of neuropathology that imaging may not detect
what cognitive functions are assessed
perception:
our interpetations of what is represented by sensory input
what cognitive functions are assessed (proper card)
Perception:
our interpretations of what is represented by sensory input
Memory:
the mental capacity to store and later recall or recognise events that were previously experienced
Language (and speech):
receptive and expressive function of language
Intellectual ability:
higher level cognitive functions (reasoning, problem solving)
what is perception made up of
sensory development and sensory integration
Auditory and visual processing
Visuospatial functioning
what are the techniques used for perception
object recognition and sound recognition/localisation
block design
what is memory made up ofvisual and auditory memory
Verbal memory
Working memory (limited capacity)
what is memory made up ofvisual and auditory memory
Verbal memory
Working memory (limited capacity)
what are the techniques used in memory
visual reproductions (impaired recent memory, visual memory)
delayed recall tasks (auditory and visual declarative memory)
digit span tests (working memory)
what is involved in language
verbal knowledge/comprehension
Reading skills
Fluency
what are the techniques used to test language
vocabulary knowledge tests (crystallised verbal knowledge)
Reading comprehension tasks (receptive language)
Naming tests and letter fluency tasks (expressive language) - Boston naming test
what is intellectual ability
attention and concentration
Processing speed (mental and psychomotor speed)
Abstract/verbal reasoning
Executive functioning (Planning, organisation, decision making)
what are the intellectual ability techniques included
Wisconsin card sorting task (attention, executive functioning)
Digit symbol task (mental processing, psychomotor speed)
WAIS-IV (executive functioning) (IQ tests)
what is the complex figure of ray
subject is asked to reproduce a complicated line drawing
Copy
Reproduce 10/15 minutes later
as accurate as possible
Minimum 2.5 mins
Maximum 5 mins
begin timing as soon as you expose drawing
what is the objective of the complex figure of Rey
to assess visual-spatial constructional ability and visual memory
Assessment of several cognitive processes
Planing
Perceptual functions
Motor functions
Attention
Working memory
diagram of the complex figure of Rey
NC: bilateral damage to medial temporal lobe
MG and PN: damage to diencephalic
what is the trail making test (TMT)
subject is asked to draw lines to connect numbers (and letters) in ascending order
As quickly as possible
Time subject as he or she connects the trail
perceptual tracking of a sequence
Speeded performance
Divided attention
—> measure of attention, speed and mental flexibility
what are the parts of the Stroop test
part 1: read colour names printed in black
Part 2: name the colour of squares
Part 3: name the colour in which the colour names are printed
as fast as possible, no mistakes
Time in seconds and number of errors
what is the Stroop test a measure of
measure of cognitive control
Interference of an automatic process (reading) with a more effort-demanding task (naming colours)
Requires response inhibition - automatic response needed
an example of the Stroop test
what is the picture completion task
part of WAIS performance scales
20 pictures that all have a vital detail missing
Test of attention to fine detail
Use standardised time and always the same
what is standardised testing
systematic administation
clearly defined procedures
reliability has been established
results compared to normative data
what is reliability
the extent to which the results or events can be replicated
what are other components of assessment
behaviour and personality
Emotional state and their mood
Degree of self regulation of mood and behaviour
Someones mood and motivation can have a significant impact on certain tests
Structural clinical interviews with patient and family
Patients assessment of their own function
