Lecture 2: Introduction to Neuropsychological Assessment Flashcards
Dissociative Seizures
a seizure or an attack that features many of the characteristics associated with focal seizures, including either retention or loss of awareness accompanied by no discernable change in EEG or any other brain scan measure
Tumors
a neoplasm, a mass of new tissue, that persists and grows independently, surrounds healthy tissue, and has no physiological use
Glioma
any brain tumor arises from glial cells
Meningiomas
an encapsulated brain tumor that grows from the meninges
Metastatic Tumor
a tumor that arises through the transfer of tumor cells from elsewhere in the body
What is mass action?
Karl Lashley (1920’s)
search for engram using rats
belief that extent of damage more important than locus
equipotentiality & plasticity
What is localization of function?
surgical patients (Penfield)
non-human animal studies
anterior intraparietal (AIP) sulcus lesions in macaques lead to inability to pre-shape hands during grasping
What is modularity of mind?
Jerry Fodor (1980’s)
encapsulated processes
essential, automatic, very fast, highly specialized systems
face recognition?
What is a closed head injury?
acceleration/deceleration
no penetration of the skull but still damage
What is cerebral oedema?
swelling
trauma, impact, tumors
What is infarction?
neuronal necrosis due to loss of blood supply
cut off of blood supply
What is a stroke?
sudden loss of blood supply
What is ischaemia?
decreased blood flow due to narrowing or blockage
buildup of plaques, narrowing blood vessels, complete blockage
What is thrombosis?
blood clot at point of formation, or embolism (not just clot)
piece has broken off and travelled
What is a hemorrhage?
burst in a blood vessel
What is a tumor?
invasion, displacement, compression
originates in glial cells
infiltrating, hard to remove
What is anoxia?
complete absence of oxygen
What is hypoxia?
% absence of oxygen
What is encephalopathy?
inflammation (disease/damage, toxic, physical agents)
pressure, tumor, hydrocephalus
What is encephalitis?
inflammation (infection)
What is hydrocephalus?
overproduction or decrease in absorption of CSF
What are the neuropsychology approaches to studying patients with circumscribed brain damage?
specific links between brain and mind (behavior)
lesion method (any type of damage)
two conceptual approaches: neural substrates, cognitive function
What is double dissociation?
damage to A but not B leads to a deficit in X not Y
lesion A –> deficit A but NOT deficit B
lesion B –> deficit B but NOT deficit A
What are the caveats to neuropsychological assessment?
large variability in population: age, sex, handedness, education, experiences, therapy
lesion variability
etiology variability
indirect observation
What are neuropsychological assessment in neurologically intact individuals?
control group: people who come to the ER, but not for brain injury
matched subjects: case by case basis
non-human animals: parietal cortex, attention, memory, visual-motor control
What is clinical neuropsychological assessment?
cognitive capacity profile: strengths & weaknesses, e.g., language function, memory, spatial ability
provides a baseline for rehab assessment
prognosis: level of expectation
done in conjunction with full neurological exam
What are the principles of assessment?
identify presence and type of mild disturbances: interview has not yielded conclusions
differentiate between brain injury and psychological disorders (e.g., depression)
deficit evaluation and rehabilitation planning (e.g., degree of speech therapy in aphasia); preserved abilities too
evaluate effects of surgery and drug therapy
evaluate scholastic problems in children (e.g., emotional?)
provide objective data for research
legal forensics (detective work) for attribution of blame
legal assessment for suitability of a person to work, retain child custody, etc.
What are the components of a Mini Mental State Exam (MMSE)?
orientation: year, month, day, date, season? where are we? probe for specificity
registration: name 3 unrelated objects & repeat back; presented as a recall task
attention & calculation: WORLD backwards, count back from 100 by 7’s (numbers)
recall: ask for names of three previous objects (delayed recall)
language: naming (watch), 3 stage commands, repeat “no ifs ands or buts”, write a sentence (spontaneous), copy geometric figure
What are standardized test-batteries?
fixed criteria for organicity
distinguish between symptoms not related to brain pathology (designed to look at specific types of functioning; if poor score, then there is something wrong with the brain)
straightforward administration, scoring, & interpretation (comparative norms)
What are individualized test-batteries?
testing tailored to patient (e.g., etiology, deficits)
requires theoretical knowledge to administer & interpret
more qualitative that quantitative (commonality of deficits across number of tasks)
What are composite test-batteries?
middle ground
quantitative & qualitative
What is the Halstead-Reitan battery?
standardized; 3-8 hours
abstract reasoning (categories test)
tactual performance (foam board with shapes)
rhythm test (nonverbal sounds - pairs S/D)
speech perception (“ee” nonsense syllables - choose from four)
10s finger-tapping
trail making (2 levels)
Wechsler Adult Intelligence Scale (WAIS-IV)
What is the Wechsler Adult Intelligence Scale (WAIS-IV)?
verbal & nonverbal subsets (e.g., visuospatial; visuomotor)
some indices include: verbal comprehension, perceptual organization/reasoning, working memory (e.g., *5Y6U1), processing speed (e.g., visual search)
What is the Rey Complex Figure?
geometric figure
ask people: copy the figure (have full vision of it while copying)
if deficit in copying: visual perceptual issue, likely not seeing it as a whole
is deficit specific to vision, perception, global LTM deficit? (delay task)
scoring: number of features and time to completion
What is the Raven Progressive Matrices test?
what are the rules of the matrix?
rule for rows and rule for columns, piece needs to fit both
figure out relationship between objects to figure out the missing piece
What is the Judgement of Line Orientation Test?
testing orientation
can have template always visible, or let them study the template then take it away
memory test
What is the Dot Localization Test?
visuospatial processing to determine what numbers they would cover on the bottom
What is measured in the Wisconsin Card Sorting task?
a person’s ability to categorize
a person’s ability to suppress a response; not get stuck on an idea
What is the issue of validity in neuropsychological assessment?
construct validity: does it test targeted cognitive function?
localization validity: does it reflect focal lesions?
diagnostic validity: does is diagnose disease?
ecologic validity: does it predict everyday-relevant behavior
What is the issue of reliability in neuropsychological assessment?
test-retest
doing it once, similar result the second time
What is the issue of premorbid functioning in neuropsychological assessment?
performance levels prior to injury
low-functioning: risk of misattributing low scores to injury
high-functioning: risk of overlooking a dysfunction due to compensatory strategies
What is the issue of compliance and malingering in neuropsychological assessment?
exaggerate mild deficit
extend deficit to match popular conception of deficit, even when deficit is legitimate
not always blatant “faking”: level of self awareness could be low
MMPI includes validity measures to help identify exaggerated or unrealistic response patterns (test question norms show even severely impaired people get it right)
professional discretion
Infection
an invasion and multiplication of pathogenic microorganisms in body tissues and the reaction of the tissues to their presence and to the toxins they generate
Viral Meningitis
inflammation of the brain’s triple-layered protective covering due to a bacterial or viral infection
Bacterium
generic name for any microorganism (typically one-celled) that has no chlorophyll and multiples by simple cell division
Bacterial Meningitis
inflammation of the brain’s triple-layered protective covering by a bacterial infection
Brain Abscesses
a localized collection of pus in the brain
formed from tissues that have disintegrated as a result of infection
Mycotic Infection
invasion of the nervous system by a fungus
Parasite
a plant or an animal that lives on or within another living organism, at whose expense it obtains some advantage
Amebiasis
an infection due to ameba that results in encephalitis and brain abscesses
also known as amebic dysentery
Malaria
an infectious febrile disease caused by protozoa of teh genus Plasmodium, which are parasitic in red blood cells
transmitted by the bites of infected mosquitos
cerebral malaria arises when the plasmodia infect the brain’s capillaries, producing local hemorrhages and subsequent degeneration of neurons
