Chapter 10 (Part 2) Flashcards
Six Reasons for Clinical Neuropsychological Assessment
- Diagnosis
- Identifying strengths and weaknesses
- Vocational and educational planning
- Treatment planning and evaluation
- Forensics (legal)
- Research
Fixed Batteries
- Same set of tests used for ever examinee
- Used by 5% of neuropsychologists
Halstead-Reitan Neuropsychological Battery
- 10 tests
- Impairment index
- General neuropsychological deficit score
- Also has an expanded version that has demographically adjusted norms for African American and Caucasian adults
Impairment Index
Uses a cutoff point to represent the presence or absence of neuropsychological deficits
General Neuropsychological Deficit Score
- Reflects the severity of neuropsychological deficit
- Godo test-retest reliability
- Discriminates brain-damaged individuals from healthy controls with 80% accuracy
Flexible Batteries
- Selection of tests varies according to reason for referral, clinical data, and patient’s ability to cooperate
- Variable but routine group of tests for different types of patients
- 78% of neuropsychologists use this approach
Mini-Mental State Examination (MMSE-2)
- Most routinely administered measure of gross cognitive functioning
- 3 Versions (brief, standard, expanded)
Brief (BV) MMSE
- 16 pts
- 5 minutes
- Used for screening large populations of individuals who haven’t been referred because of cognitive complaints
Standard (SV) MMSE
- 30 pts
- 15 minutes
- Used if patient is referred because of good cognitive complaints or if patient indicates memory is not as good as it used to be
Expanded (EV) MMSE
- 90 pts
- 20 minutes
- Used for well-educated patients and/or patients with suspected subcortical dementia
- Consists of all items on the SV plus story memory and processing speed
MMSE-2 Psychometrics
- Has few items, so internal consistency is not the greatest
- Excellent inter-rater reliability
- Convergent validity
Convergent Validity of MMSE
Expected patterns of correlations with several tests that measure specific aspects of cognitive functions (such as Boston Naming Test, Stroop Test, etc.)
Intelligence
Estimates of premorbid IQ levels and may be used to determine school records or formulas
Achievement
- From school records
- Individually administered tests (such as Wide-Range Achievement Test)
Continuous Performance Tests (CPTs)
Measure the ability to respond to sequentially presented target stimuli and avoid responding to interspersed non-target stimuli over a long period of time and in the face of boredom
CPTs Measurement
- Measure ability to maintain alertness
- Also called vigilance or sustained attention
- Brain areas involved include the reticular formation and frontal lobes (hindbrain)
WAIS-IV Attention/Concentration
- Digit span (forward and backward)
- Letter/number sequencing
- Arithmetic (word problems)
- Involves frontal lobes (mainly dorsolateral prefrontal cortex)
Trail-Making Test, Part A
- Halstead-Reitan
- Draw a line connecting 25 numbered circles in order as fast as possible without lifting the pencil off the page
Naming Ability
- Dysnomia
- Most frequently impaired linguistic function in individuals with neurological disease
- Usually assessed by procedures that require naming of line drawings and objects on visual confrontation
Boston Naming Test
- Most popular naming test
- 60 line drawings of objects arranged in increasing order of difficulty
- Involves left temporal lobe
Controlled Oral Word Association Test (COWAT)
- Also called verbal fluency
- Letter (phonemic, left frontal lobe)
- Semantic (category, left temporal lobe)
- 60 seconds for each category
Constructional Apraxia
- Inability to assemble or copy 2 or 3-dimensional objects
- Block design on WAIS-IV requires a person to reproduce a 2x2 or 3x3 design with red and white blocks
- Hooper test has 30 common objects cut into pieces, examinees need to assemble the pieces in their head and name the object
- Involves posterior brain areas (superior parietal lobes, temporal-occipital cortex, and posterior visual association areas)
Neglect
- Inattention to the side of space contralateral to the lesion location
- Usually left side of space due to right parietal lobe damage
Line Bisection
Examinee is asked to bisect lines on a page placed at midline
Clock Drawing
- Examinee is first asked to draw a clock to command (e.g. set the time for 10 after 11)
- Then asked to copy a clock drawing with the hands already set
Memory Probems
- Most frequent complaints by persons referred for a CN evaluation
- Verbal and nonverbal memory tests
- Verbal > left hemisphere > California Verbal Learning Test (CVLT-II)
- Nonverbal > right hemisphere > Rey Complex Figure Test (RCT)
California Verbal Learning Test (CVLT-II)
- Age range of 16 to 89 years
- 16 item word list
- 5 learning trials
- Followed by a distracter list of 16 new words
- Immediate and long delay free recall and cued recall trials
- Yes/no long delay recognition trial
- Also has forced choice long delay recognition trial
Motor Functioning
- Three major areas assessed
- Grip strength (Hand-Dynamometer)
- Fine motor (Grooved Pegboard Test)
- Motor Speed (Finger-Tapping, WAIS-IV Processing speed tests)
Coding
- Fill in the empty boxes as quickly as possible using given code
- Taps psychomotor speed, visual attention, and concentration
Cancellation
- When told, draw a line through every specified shape
- Taps psychomotor speed, as well as visual selective attention
Symbol Search
- Task is to determine whether either symbol on the left is included in the group of symbols on the right
- Taps psychomotor speed and visual scanning ability
Executive Functions
Supervisory cognitive processes involved in the organization and execution of complex thoughts and behaviors
Three Commonly Used Executive Functioning Tests
- Trail-Making Test, Part B (scattered numbers and letters, must connect circles in order, alternating numbers and letters)
- Stroop Test
- Wisconsin Card Sorting Test
Stroop Test
- Word reading (3 color words printed in black ink)
- Color naming (X’s printed in colored ink that correspond to previous colors)
- Incongruent Color Naming (colored ink is different than the color to be named)
Dorsolateral Prefrontal Cortex (Stroop Test)
Participants showed more activation here when putting their mind to the job of ignoring the words while naming the color
Anterior Cingulate Cortex (Stroop Test)
Participants showed more activation here when monitoring for conflicts and inhibiting prepotent responses
Wisconsin Card Sorting Test
- Most frequently used EF test ( > 70% of neuropsychologists)
- 4 stimulus cards, 128 response cards
- Variations in color, form, and number
- Examinee is not informed of sorting criteria
- 6 categories, 10 each
- Test continues until 6 categories are completed or 128 cards are used
- Possibility of perseveration (inability to switch between patterns of thought)
Minnesota Multiphasic Personality Inventory (MMPI)
Most frequently used objective personality inventory
Beck Depression Inventory (BDI)
Most widely used self-report measure of depression
Effort and Motivation
Used to determine symptom validity
Malingering
Faking or exaggerating deficits for secondary gain
