Chapter 28 Flashcards
beginning of neuropsychological assessment
kurt goldstein
- clinician who was expert in neurology, psychology and psychiatry
- pushed the development of psychological assessment for neurological patients, and especially returning veterans after World War II
first neuropsychological tests
designed to identify people with cerebral dysfunction attributable to organic disease processes (brain pathology) rather than to functional disorders linked to behavior
factors that have enhanced the rate of change in neuropsychological assessment
- functional brain imaging
- cognitive neuroscience
- managed healthcare
functional brain imaging
- early days - cerebral injury or disease had to be inferred from behavioral symptoms
- neuroimaging allows investigators to identify changes in cerebral functioning in a wide variety of disorders
- clinical neuropsychologist’s main role changed to participant in rehabilitation, especially in case of chronic diseases such as stroke and head trauma
- neuroimaging does not predict the extent of behavioral disturbance observed in people with certain types of brain injury, especially head trauma
- for people with closed-head injury, often the only way to document the nature and extent of disability is by a thorough neuropsychological assessment
cutoff scores challenges
performance below a particular level cannot always be taken as indicative of brain damage
- cerebral organization changes with many factors
- varies with factors such as sex, handedness, age, education, culture, and life experience
- problem-solving strategies vary
- and can thus entail different cortical regions, and symptoms of cortical injury can be highly specific
- task performance may depend on intelligence
- lack of neurological theory in test development
- knowledge of brain function was based largely on critical observation
emergence of cognitive neuroscience
- case studies
- each directed by sophisticated cognitive theories and assisted by structural and functional imaging technologies
- imaging technologies to attempt to understand how the neural networks and the connectome are disrupted
- such as structural regression modeling
- multivariate statistical methods
clarifying the functions of the right frontal lobe
(contribution of cognitive neuroscience)
- historically, the right frontal lobe proved remarkably unresponsive to neuropsychological assessment
- combination of functional imaging and neuropsychological test development led to an understanding of the right frontal lobe’s role in formerly in-assessable functions, including social cognition
managed healthcare
assessment procedure
- diagnostic measure clearly linked to treatment options
- efficiency in cost and time
- integrated progress tracking - treatment planning, progress monitoring, outcome evaluation
standardized test batteries
- fixed criteria to distinguish pathological behavior
- organicity criteria are used to distinguish behavioral symptoms from those not directly related to brain pathology
- organicity: atypical behavior has a biological basis
- straightforward administration, scoring, interpretation
- Cambridge Neuropsychological Test Automated Battery (CANTAB)
individualized test batteries
- require particular theoretical knowledge to administer and interpret
- qualitative assessments
- customized tests for individuals (etiology and performance)
composite test batteries
- standardized + individualized test batteries
- consist of comparable norms and qualitative performance assessments
- administered in a formalized way and may have comparison norms, but qualitative performance and the pattern of those results are also considered
- some are tailored to individuals
choosing tests
- the etiology of the neurological disorder
- sensitivity of the tests
- various factors may interact with brain pathology to make interpreting test results difficult, including individual characteristics
- individual characteristics
- significant difference in test performance are related to factors such as gender and handedness
- intelligence
goals of neuropsychological assessment
- to determine level of cerebral functioning
- to identify and localize cerebral dysfunction, mild disturbances, unusual brain organization
- to record the functional recovery post injury
- to facilitate realistic patient care and rehabilitation
intelligence testing
two ex
- (WAIS-IV)
- determining a base level of cognitive functioning
- performed on people aged 16-19, has 10 core subtests and 5 supplemental subtests
- the full scale IQ (FSIQ)
- the 10 core subtests comprise the Full Scale IQ, FSIQ
- mean of 100 and stdev of 15
identify cerebral dysfunction and brain activity
- Neuropsychological tests have been developed to identify cerebral dysfunction under the presumption that they actually measure the activity of specific brain regions.
- However, cognitive processes correspond to the activity of brain networks widely distributed.
- to fix this: to find what brain regions are active during specific tests → employ noninvasive imaging as control participatns perform one or more tests
- interpretation of neuropsychological test performance should move away from the historical anatomical localization approach, to an approach more consistent with the developing view of connectivity and extended neural networks
language processing networks → brain activation during frontal lobe tests
- revealed clearly reliable activation of frontal regions when subjects performed tasks such as the Wisconsin Card Sorting Test, Stroop Test and Chicago Word Fluency Test
- but activation always appears in different cerebral regions too
- more extended activation presumably occurs because the frontal cortex participates in several extended brain networks
malingering
determining whether subjects are performing tests as requested, or are malingering, typically by exaggerating their cognitive deficits
- effort has greater effect in test performance than brain damage
- poor performance of effort tests not only affects memory performance but also performance across entire test battery
- forced choice digit memory test by merrill hiscock
Case Study 1
33 yo man with history of seizures for 4+ years
- increasingly frequent seizures with head and eyes turning to right
- supplementary motor cortex involvement
- radiological and EEG studies suggest left frontal lobe lesion
- left frontal lobe lesion confirmed at surgery
- difficulty with Wisconsin card sorting test (1 category), which remained after surgery
- preseverative errors
- If this patient was like other patients with similar lesions, on follow up a year after surgery, his intelligence ratings and memory scores would likely have returned to the preoperative level. His card sorting however will be unlikely to show any improvement.
Case Study 2
26 yo man with history of seizures for 8 years
- seizures in left side of face and left hand
- uncontrolled by meds
- normal limits on intelligence and general memory tests
- difficulty with delayed recall of verbal material
- defects of finger position sense on the left hand, weakness in the left arm and leg
- right central cortical area damage
- inability to perform Wisconsin cart sorting test
- lesion into frontal and temporal areas
- post-surgery residual epileptiform abnormality in the frontal lobe and superior temporal gyrus
- improvement in verbal IQ and long term verbal memory
- persistent difficulties on the card sorting test and finer position sense on the left hand
kurt goldstein
- clinician who was expert in neurology, psychology and psychiatry
- pushed the development of psychological assessment for neurological patients, and especially returning veterans after World War II
beginning of neuropsychological assessment
designed to identify people with cerebral dysfunction attributable to organic disease processes (brain pathology) rather than to functional disorders linked to behavior
first neuropsychological tests
- functional brain imaging
- cognitive neuroscience
- managed healthcare
factors that have enhanced the rate of change in neuropsychological assessment
- early days - cerebral injury or disease had to be inferred from behavioral symptoms
- allows investigators to identify changes in cerebral functioning in a wide variety of disorders
- does not predict the extent of behavioral disturbance observed in people with certain types of brain injury, especially head trauma
functional brain imaging
performance below a particular level cannot always be taken as indicative of brain damage
- cerebral organization changes with many factors
- varies with factors such as sex, handedness, age, education, culture, and life experience
- problem-solving strategies vary
- and can thus entail different cortical regions, and symptoms of cortical injury can be highly specific
- task performance may depend on intelligence
- lack of neurological theory in test development
- knowledge of brain function was based largely on critical observation
cutoff scores challenges
- case studies
- each directed by sophisticated cognitive theories and assisted by structural and functional imaging technologies
- imaging technologies to attempt to understand how the neural networks and the connectome are disrupted
- such as structural regression modeling
- multivariate statistical methods
emergence of cognitive neuroscience
- historically, the right frontal lobe proved remarkably unresponsive to neuropsychological assessment
- combination of functional imaging and neuropsychological test development led to an understanding of the right frontal lobe’s role in formerly in-assessable functions, including social cognition
clarifying the functions of the right frontal lobe
(contribution of cognitive neuroscience)
- diagnostic measure clearly linked to treatment options
- efficiency in cost and time
- integrated progress tracking - treatment planning, progress monitoring, outcome evaluation
managed healthcare
assessment procedure
- fixed criteria to distinguish pathological behavior
- organicity criteria are used to distinguish behavioral symptoms from those not directly related to brain pathology
- organicity: atypical behavior has a biological basis
- straightforward administration, scoring, interpretation
- Cambridge Neuropsychological Test Automated Battery (CANTAB)
standardized test batteries
- require particular theoretical knowledge to administer and interpret
- qualitative assessments
- customized tests for individuals (etiology and performance)
individualized test batteries
- standardized + individualized test batteries
- consist of comparable norms and qualitative performance assessments
- administered in a formalized way and may have comparison norms, but qualitative performance and the pattern of those results are also considered
- some are tailored to individuals
composite test batteries
- the etiology of the neurological disorder
- sensitivity of the tests
- various factors may interact with brain pathology to make interpreting test results difficult, including individual characteristics
- individual characteristics
- significant difference in test performance are related to factors such as gender and handedness
- intelligence
choosing tests
- to determine level of cerebral functioning
- to identify and localize cerebral dysfunction, mild disturbances, unusual brain organization
- to record the functional recovery post injury
- to facilitate realistic patient care and rehabilitation
goals of neuropsychological assessment
- (WAIS-IV)
- determining a base level of cognitive functioning
- performed on people aged 16-19, has 10 core subtests and 5 supplemental subtests
- the full scale IQ (FSIQ)
- the 10 core subtests comprise the Full Scale IQ, FSIQ
- mean of 100 and stdev of 15
intelligence testing
two ex
- Neuropsychological tests have been developed to identify cerebral dysfunction under the presumption that they actually measure the activity of specific brain regions.
- However, cognitive processes correspond to the activity of brain networks widely distributed.
- to fix this: to find what brain regions are active during specific tests → employ noninvasive imaging as control participatns perform one or more tests
- interpretation of neuropsychological test performance should move away from the historical anatomical localization approach, to an approach more consistent with the developing view of connectivity and extended neural networks
identify cerebral dysfunction and brain activity
- revealed clearly reliable activation of frontal regions when subjects performed tasks such as the Wisconsin Card Sorting Test, Stroop Test and Chicago Word Fluency Test
- but activation always appears in different cerebral regions too
- more extended activation presumably occurs because the frontal cortex participates in several extended brain networks
language processing networks → brain activation during frontal lobe tests
determining whether subjects are performing tests as requested, or are malingering, typically by exaggerating their cognitive deficits
- effort has greater effect in test performance than brain damage
- poor performance of effort tests not only affects memory performance but also performance across entire test battery
- forced choice digit memory test by merrill hiscock
malingering
The authors suggest that the biggest change in neuropsychology since the 1980s has been the development of _________.
functional imaging
better psychiatric drugs
better paper and pencil tests
increased treatment of those suffering from psychological disorders
functional imaging
Prior to the development of brain imaging tests such as MRI and PET, neuropsychologists relied primarily on _____ to provide information regarding localization of cerebral damage.
behavioral tests
The combination of neuropsychological test development and imaging techniques has led to an understanding of the role of the right frontal lobe in ________.
social cognition
The Wechsler scales are used to assess ________.
intelligence
The FSIQ has a mean of ___ and a standard deviation of ___.
100
15
During the Wisconsin Card-Sorting Test, Stroop Test, and Chicago Word-Fluency Test, imaging has shown that subjects demonstrate activation in the ____________.
frontal lobe
The MOST sensitive measure of malingering is the _________.
Forced Choice Digit Memory Test
Which of the following is a computerized neuropsychological test battery?
CANTAB
Boston Process
Halstead-Reitan
Luria-Nebraska
CANTAB
A 33-year-old man with frontal lesion (Case 1) would probably show improvement on follow-up tests given a year after surgery, with the exception of scores on _______.
the Wisconsin Card-Sorting Test
Identify the methodology MOST commonly used to evaluate a patient for epilepsy.
EEG
brain injured clients who present as being in vegetative or low awareness states
a. cannot be reliably assessed using neuropsychological tests
b. can be reliably assessed using traditional tests
c. can be reliably assessed using structured behavioral observation tests
d. none of the above
c. can be reliably assessed using structured behavioral observation test
which of the following factors can be addressed in the planning assessment session?
a. their motivation to engage in assessment process
b. emotional state
c. fatigue
d. attentional abilities
e. none
c. fatigue
