Chapter 3 - Neuropsychological Assessment Flashcards
What specialist performs assessments and administers tests to diagnose behaviors?
Neuropsychologists
What are the goals of a neuropsychological assessment?
- diagnose presence of cortical damage (assess cog. function) and localize it
- facilitate pt care
- ID mild disturbances (microscopic damage)
- ID unusual brain organization
- ID cause of disorders
- Rehab
- Help pt and family understand their disorder
Psychometrics
- Science of measuring human traits or abilities.
- standardization of psychological and neuropsychological tests
- neuropsychometrics are sensitive to behavior
Reliability
- stability or dependability of a test score
- test results can be reliable but not valid
Validity
whether or not the test is measuring what it is supposed to measure
Why is it important that neuropsychological tests be reliable and valid?
so that pts are not misdiagnosed
False Positive
test erroneously indicates a condition
Base rate
frequency w/ which a pathologic condition is diagnosed in the population tested
What types of test are most commonly used by psychologists?
- achievement - how the ind. has profited from learning and experience (exams)
- aptitude - future functioning (GRE, MCAT)
- behavioral/adaptive - what the pt. habitually does (day to day tasks)
- intelligence - IQ score, working mem., learning, verbal and nonverbal
- neuropsychological - sensitive to all changes in brain
- personality - diff personality traits, i.e. introvert vs. extrovert (MMPI)
- vocational - opinions and attitudes regarding diff. areas like professions
Fixed battery
- comprehensive and fixed set of tests
- EX: Halstead-Reitan Neuropsychological Battery, Wechsler Adult Intelligence Scale, Luria-Nebraska Neuropsychological Battery
What are the pros and cons of a fixed battery?
Cons
- time-consuming, all tests must be conducted
- neuropsychologist may not have seen pt. if tests are given by a tech
- something could be missed, tests cannot be altered to assess all concerns
Pros
- patients are easy to compare and assess b/c tests are standardized
Flexible battery
- selection and administration of an array of tests based on pt’s presenting complaints
What are the pros and cons of a flexible battery?
Cons
- patients cannot be easily compared
- possible bias could cause neuropsych. to miss a test
- no longer standardized
Pros
- tests can be changed/altered to fit concerns
- neuropsych. selects tests, giving the ability to hone in on specific traits
How does a neuropsych choose the test battery?
- interview
- background data
- history of symptoms
- medical history
- family history
- developmental
- drug history
- educational history
- employment history
Orientation/Arousal
- pt’s basic awareness of themselves to the world around them
- assessment involves eval. of orientation in terms of place, person and time (What’s the date? What’s your address? What’s your name)
What is the standardized test for orientation?
- Galveston Orientation and Amnesia Test (GOAT)
- assess extent and duration of confusion and amnesia after TBI
- 0-100, 75 or better indicates normal functioning
Sensation and perception
- assess pt.’s visual, auditory, and tactile functional levels
- can be done by optometrist or audiologist
What are the common tests for sensation and perception?
- Halsteid-Reitan Neuropsychological Battery - standardized
- includes a sensory-perceptual examination like tactile testing (feeling and ID objs) - nonstandardized
Attention and Concentration
- sustained attention - paying attention to something over prolonged period of time
- selective attention - paying attention to more than one thing at a time
What are the common tests for attention and concentration?
- Symbol digit modalities test (SDMIT) - #s and symbols, must match each
- d2 test - visual cancellation test
- nonstandardized - digit span test (repeat numbers in instructed order), say the alphabet backwards
Motor Skills
- assess of pt.’s motor control in the upper and lower extremities
- measuring simple and complex motor skills
What is the common test for motor skills?
- standardized - finger-tapping speed from the Halsteid-Reitan and grip strength
- nonstandardized - follow motor commands
Verbal Functions/Language
- assess simple spoken language as well as more complicated areas like:
- word repetition
- naming
- word production
What is the common test for verbal functions/language?
- standardized - the Controlled Oral Word Association (COWA) - name as many words you can starting w/ a specific letter
- standardized - Token test - point and touch diff. colored tokens
- nonstandardized - define words, generating sentences using a specific word
Visuospatial Organization
- assess diff. areas of processing such as spatial orientation, facial recognition, and visual sequencing
What is the common test for visuospatial organization?
- standardized - The Bender Gestalt test - copy geometric shapes, graded on accuracy
- standardized - The Rey-Osterrieth Complex Figure Test - copy abstract shapes, graded on accuracy
- nonstandardized - draw the face of a clock at a certain time, recognition of facial expressions
Memory
- immediate and delayed memory (verbal and visual formats)
What is the common test for memory?
- standardized - Wechsler Memory Scale (WMS) - measures verbal and nonverbal mem
- nonstandardized - repeat a story, recall ability of specific words
Judgement/Problem Solving
- abstract reasoning/insight and problem solving
What is the common test for judgement/problem solving?
- standardized - Trail Making Test B, Wisconsin Card Sorting Test, Tower of London-Drexel University
- nonstandardized - what-if situations
What is the most common test for frontal lobe damage?
- Wisconsin Card Sorting Test - sort cards depending on an unknown set of rules, pt. has to learn rules through trial and error
- shifting of strategies
Neuropsychological diagnoses provide info in areas such as:
- mild head injuries
- ADHD
- learning disability
- Alzheimer’s disease
Malingering
- exaggerating cognitive deficits
- external incentives could play a role in performance (benefits, disability, lawsuits etc.)
- neuropsych are trained specifically to detect this
