Chapter 28 Flashcards
Neuropsychological testing can reveal
the nature and extent of injuries
Interaction of neurocognitive factors, psychological factors, and socioenvironmental factors influences
how someone can adapt to their injury
It can be important to understand the
biopsychosocial factors for a patient before starting the neuropsychological assessment
3 questions evolved from the biopsychosocial model of measurement
Questions about history of disease, addiction, and family medical history, Questions about stressors and psychological issues, Questions about living arrangements, relationships, and finances
Neuropsychological assessment grew out of neurology and psychology to assess
veterans returning from World War II
Goal of Neuropsychological testing
have one test to identify brain damage versus no brain damage
was it possible to have one test that determined if brain damage was possible
no
by the 1980s what became more standardized?
neuropsychological assessment many tests had been developed to assess different functions
Benton’s neuropsychological investigation test type
Composite
Boston Process Approach Test type
Composite
Oxford neuropsychological procedures test type
Composite
Montreal Neurological Institute approach test type
Composite
Frontal-lobe assessment Test type
Composite
Western Ontario procedures test type
Composite
Halstead–Reitan Battery test type
Standardized
Luria’s neuropsychological investigation Test type
Standardized
Luria–Nebraska Battery test type
Standardized
CANTAB test type
Computerized
Neuropsychological test batteries
individual tests of a wide range of functions, to capture qualitative features of test performance in patients with a wide range of neurological and psychiatric conditions
what happened in the 1980s
emergence of the field of cognitive neuroscience
Clinical Role of Neuropsychology
not just to diagnose the disorder, but to be a participant in the rehabilitation of the patient
30% of patients are seen for
Rehabilitation
70% of patients are seen as
referrals from neurology and psychiatry
What is the purpose of an assessment
to determine general cognitive functioning
Houston Guideline for Neuropsychology established
the qualifications for neuropsychological assessment
Functional imaging and neuropsychology
is useful, but does not replace a thorough assessment
Houston Guidelines identify seven core domains in neuropsychology
Assessment, Intervention, Consultation, Supervision, research and inquiry, consumer protection, professional development
Standardized tests assess
organicity, which is atypical behavior that has a biological basis
Standardized tests are
straightforward to administer and interpret - true false and multiple choice
Individualized test batteries
Neuropsychological tests tailored both to a person’s etiology and to the qualitative nature of his or her performance on each test.
Individualized tests produce
qualitative results
Individualized tests are designed to understand
the individual’s strengths
Composite tests
incorporate aspects of both types of test
Goal of Neuropsychological assessment
to diagnose a disorder for the purpose of changing behavior
goals of clinical neuropsychology are (7)
Determine a person’s general level of cerebral functioning and identify cerebral dysfunction and localize it where possible, Facilitate patient care and rehabilitation, dentify mild disturbances when other diagnostic studies have produced equivocal results, Identify unusual brain organization that may exist in left-handers or in people who have had a childhood brain injury, Corroborate an abnormal EEG in disorders such as focal epilepsy, Document recovery of function after brain injury, Promote realistic outcomes
Most neuropsychological assessments begin with a measure of
general intelligence
test most often used in intelligence testing
Wechsler scales
The WAIS-IV has
10 core subtests and 5 supplemental subtests
5 supplemental subscales
General ability, verbal comprehension, perceptual reasoning, working memory, and processing speed
Weschler tests take
about 70 minutes, but can be faster if only the general ability subscale is used
Weschler tests is normed so that a score of
100 is average and the standard deviation is 15
After a TBI a difference in IQ score of ___ between which subsets is significant?
more than 10 points between the verbal and perceptual subtests is often taken to be clinically significant
Left hemisphere damage is associated with what impairment
verbal subscale
Patients with diffuse damage tend to be impaired on
the perceptual subscale
Ten Commonly Assessed Neuropsychological Categories
- Abstract reasoning and conceptualization, 2. attention, 3. daily activities, 4. Emotional or psychological distress, 5. language, 6. Memory, 7. motor, 8. orientation, 9. Sensation and perception 10, Visuospatial
do all clinicians use the 10 categories of common neurological assessment
no
10 categories of common neurological assessment can be used to
track and understand child development
most significant improvement of raw neurological assessment scores between ages when does rate of change plateau?
6-10, adolescence
Sports medicine
monitoring for symptoms of concussion, is a growing area of neuropsychological assessment
Children are often evaluated when
academic performance falls behind their peers or there are behavioral issues
what test is used to assess children ages 6-16
Wechsler Intelligence Scale for Children (WISC)
what test is used to assess children ages 2 years 6 months to 7 years 7 months
Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
Subscale scores in children can help identify
ADHD and learning disabilities
Ten Core Features of Neuropsychological Assessment
- Collaborative, 2. Assess Early 3. Developmental History 4. Comorbidities, 5. Subjective Complaints, 6.Maximize Potentials, 7. Not for Everyone 8. Limitations 9. Adequate Intervals 10. Transparency
Collaborative feature
The neuropsychological assessment is collaborative, not just based on tests but also other factors like anxiety, diet etc.
early assessment feature
Assessment prior to treatment allows for the accurate understanding of treatment effects
Developmental History feature
An individual’s neurodevelopmental history plays as important a role as the nature of the injury or disease in shaping the associated neuropsychological deficit. stress or socioeconomic status, can influence the development and connectivity of the brain
Comorbidities feature
Cognitive and behavioral impairments can result from comorbidities
Subjective Complaints feature
The subjective complaints of patients and family members can help understand the nature of the neuropsychological deficit
Maximize Potentials feature
The results from a neuropsychological assessment can be used to maximize the educational and occupational potentials of people with brain injury.
Not for Everyone feature
Not all patients are able or willing to engage with neuropsychological assessment
Limitations feature
here are limitations to assessments that have been standardized for a population different from the patient or that are conducted in a language that is not the patient’s native language
Adequate Intervals feature
Adequate intervals between assessments maximize sensitivity to meaningful changes in behavior
Transparency feature
Patients should be fully informed about the purpose of the assessment and have realistic expectations of the outcome prior to referral
Practice effects
he influence of repeated exposure to a given test can have a significant impact on test performance, especially in the short term
The Problem of Effort
determining whether patients are performing tests as requested or are malingering, typically by exaggerating their cognitive deficits
Effort, or lack thereof, has a greater impact on
test performance than does brain damage
Clinical judgement is not reliable in detecting
malingering
Symptom validity testing assesses
whether the subject is making a good-faith effort on the test
Estimates are that clinical neuropsychological assessment is about
30 years behind advances in neuroscience
five principles that should guide modern neuropsychological test design
- Leverage information from response alternatives 2. Link tests, 3. take advantage of computerized adaptive testing (CAT) 4. Identify differential item functioning (DIF) factors 5. Analyze person fit statistics
Leverage information from response alternatives
In multiple-choice tests, the wrong answer can be wrong in different ways, so analyze those to understand why the subject chose that answer
Linked tests
Link items from different tests so that they are on a common scale to compare assessments of a single trait from different scales
Take advantage of computerized adaptive testing (CAT)
Use computerized adaptive testing to adjust the difficulty of testing to the subject’s ability and speed up the testing process
Identify differential item functioning (DIF) factors
Identify items on the test that produce different responses in different demographic groups to be able to make more universal tests
Analyze person fit statistics
Analyze the responses to individual items to identify when the subject is not performing at the same level as before
