ch 2: neuropsychological assessment Flashcards
What are the primary purposes of clinical assessment?
To conduct a differential diagnosis, describe behavior, predict risks and outcomes, monitor treatment responses, and guide interventions.
What is differential diagnosis in clinical assessment?
Determining whether symptoms are due to different possible causes, such as a dementing process issue vs. substance use issue.
Why is describing behavior important in clinical assessment?
To understand the effects of specific conditions (e.g., head injury) on executive, language, or motor functions.
How does clinical assessment help predict risks and outcomes?
It assesses whether an individual can return to work or resume previous activities.
How does clinical assessment monitor treatment responses?
By evaluating the effectiveness of treatment and determining whether modifications are needed.
What is neuropsychological testing?
An objective, comprehensive assessment of cognitive and behavioral functioning.
What types of information should be gathered about the patient?
Medical, social, academic, and other contextual information.
What are the key concepts in assessment?
Reliability, validity, and standardization.
What is reliability?
Consistency in measurement (e.g., test-retest, split-half, internal consistency).
What is validity?
Measuring what the test is intended to measure (e.g., face validity, ecological validity, criterion-oriented validity).
What is standardization?
Consistent use of a technique or device, ensuring questions are asked the same way for all individuals.
What is test-retest reliability?
Comparing scores of a test taken at two different times.
What is split-half reliability?
Administering one test, splitting it into two parts, and correlating the scores to avoid practice effects.
What is inter-rater reliability?
Ensuring consistency when multiple individuals rate or judge a phenomenon using the same rubric.
What is face validity?
The test appears to measure what it is supposed to measure (e.g., asking about recent depression).
What is ecological validity?
The extent to which test results mimic real-world functioning.
What is criterion-oriented validity?
How well scores differentiate between people with and without a specific condition (e.g., concurrent or predictive validity).
concurrent validity
currently possess the ability to do the task that is asked; e.g., blood test comes back positive for a disease
predictive validity
- score will determine that you will have it
- Does the test correlate with future abilities/behavior?
What is construct validity?
Whether the test measures the concept it claims to measure.
How is construct validity established?
Through convergent validity (correlation with gold standard tests) and discriminant validity (no correlation with unrelated constructs).
What are the outcomes in signal detection for diagnosis
hit, false positive, false negative, correct rejection
hit
disease present, test positive
false alarm (type 1 error)
disease absent, test positive
miss (type 2 error)
disease present, test negative
correct rejection
disease absent, test negative
What influences predictive value in testing?
The base rate, or percentage of people in the population with the condition
Why do rarer disorders have poorer predictive value?
Because the base rate is lower, reducing the accuracy of positive tests.
positive predictive value (PPV)
percent of positive tests that were accurate
negative predictive value (NPV)
percent of negative tests that were accurate
sensitivity
percent of people with the disorder who were correctly identified
specificity
percent of people without the disorder who were correctly identified
What are the 2 primary approaches to a neuropsychological assessment?
flexible battery and fixed battery
flexible battery
a large range of tests available and we pick and choose the ones we believe are most helpful for the research question/patient we are evaluating
What are the strengths of the flexible battery approach?
Lack of redundant testing, lower costs, individualized focus, and emphasis on why tasks are failed.
What are the weaknesses of the flexible battery approach?
Confirmation biases, subjectivity, lack of standardization, and reduced usefulness for research.
fixed battery
A predetermined set of tests used for every patient
What are the strengths of the fixed battery approach?
Comprehensive, standardized, good for research, and useful for teaching.
What are the weaknesses of the fixed battery approach?
Time-consuming, lacks qualitative observations, and is rigid.
What are the main steps in neuropsychological assessment?
Reviewing background, conducting interviews and mental status exams, testing, writing reports, providing feedback, and follow-ups.
What are the domains of an assessment? (My Soup Lacks Many Hot Peas)
- motor
- sensory
- language
- memory
- higher cognitive functioning
- personality/emotional
What do motor skills tests test for?
- Fine and gross manual motor speed/dexterity
- Graphomotor skills (drawing tasks) and motor apraxia (ability to carry out motor sequences)
What do sensation and perception tests test for?
- sensory/perceptual systems’ functioning
- tests like HRNB sensory/perceptual exam
- visuospatial functioning
stereognosis
identifying objects by touch
anosmia
loss of smell
visuospatial functioning
higher-level skills (clock drawing, map reading, facial recognition)
What do language tests test for?
- receptive/comprehension
- expressive speech
- fluency
- reading, writing, spelling
What do memory tests test for?
- episodic memory (explicit events)
- semantic memory (basic facts)
- retrograde vs. anterograde memories
- acquisition, recall, recognition
What do higher cognitive function tests test for?
- attention/concentration
- executive function
- personality/mood
What are some procedural considerations for neuropsychological assessment?
- test order
- motivation
- testing of limits
- practice effects
- use of technicians
- special populations
