lecture 9- neuropsychological assessment Flashcards
Case studyRamanathan et al. (2018)
- JD: aged 54, 18 years of education
Severe closed-head injury from car accident
- Frontal and temporal lobe damage
Reported issues
- Mild speech and motor problems
- Unable to return to work
- Difficulties with multitasking, time management, memory, social interactions.
Neuropsychological testing:
- Problems attention & executive function
- Intensive rehabilitation resulted in improvements in executive function, time management and functional ability
assessing current cognitive functioning:
- intelligence
- memory
- language
classes of cognitive functions-
- sensory reception and perception
- memory
- thinking and decision-making
- motor functions
- language
- numerical processing
- executive function and attention
structure of the WAIS-IV
Clinical assessment with the WAIS
Use intelligence test as initial screening assessment
- To help decide which areas to explore in more detail
- Standardised tests with observation
- May use shortened version involving fewer subtests
- Gives overall FSIQ and index scores
- Extensive standardization, excellent norms, good reliability and construct validity
Weaknesses of WAIS
- Does not assess executive functions
-Predictive validity and treatment validity poorer than other tests
what are the different types of memory?
- short term memory
- working memory
- long term memory (anterograde v retrograde, verbal v non verbal, semantic v episodic)
- procedural or implicit memory
- prospective memory
Wechsler Memory Scales (WMS)
- Mean = 100, SD = 15: co-normed with WAIS
Multiple subtests assess:
- Auditory-verbal immediate & delayed memory
- Visual-spatial immediate & delayed memory
- Working memory
Evaluation (see e.g. Kent, 2013)
- Good reliability
- WMS more sensitive to head injury than WAIS
- Does not assess procedural or prospective memory
=>WMS IV no assessment of verbal working memory
- Not linked to neuroanatomical theory of memory
- Factor structure not as proposed in manual
assessing language
Aphasia
- Language impairments
Clinical examination
- Spontaneous speech and observation
- To diagnose presence of aphasia
Diagnostic tests
- E.g. Boston Diagnostic Aphasia Exam (BDAE III)
- To pinpoint nature of language problems (aphasia)
- To provide guidance for rehabilitation
- 8 subscales: fluency, auditory comprehension, naming, oral reading repetition, automatic speech, reading comprehension, writing.
what is the cookie theft task
The Cookie Theft Task is a well-known component of the Boston Diagnostic Aphasia Examination (BDAE), designed to assess language and communication skills in individuals who may have aphasia or other language impairments. Specifically, this task evaluates connected speech—the ability to produce coherent and meaningful spoken language in a narrative format.
What the task involves:
Stimulus: The task uses a black-and-white line drawing titled The Cookie Theft. The image depicts a scene where a boy and girl are attempting to steal cookies from a jar on a precariously balanced stool while their mother is distracted at the sink, with water overflowing from the faucet.
Instructions: The individual being tested is asked to describe what they see in the picture.
What it measures:
Speech fluency: How easily and fluidly the person can produce speech.
Grammar: The use of appropriate syntax and morphology.
Word finding: The ability to retrieve and use the correct words.
Cohesion and coherence: How well the description flows and makes sense.
Content: How much information the person provides about the scene.
Error patterns: Such as paraphasias (word substitutions) or omissions.
Evaluation of BDAE
Very wide range of tasks (34 subtests!)
- Includes structured interview, observation and tests
- Time-consuming, requires specialist training
Evaluation
- Norms for aphasic patients, and small normal sample
- Reliability acceptable, lower for ‘qualitative’ scales
- Construct validity, diagnostic validity and treatment validity good
e.g. Fong, Van Patten & Fucetola (2019): Factor analysis in 355 people with aphasia confirmed factor structure of the BDAE III
- But only valid for those with relevant education and language exposure
executive functions (EFs)
- Self-regulation processes
- Predict functional outcomes better than other cognitive variables
=>Ecological validity important
Struchen et al. (2008)
- 121 people with brain injury
- EFs predicted:
=>Return to work, social integration, marital success, and caregiver burden
- Better than other measures of cognitive or physical functioning
Executive function measures predict return to work in a bipolar sample Drakopoulos et al. (2020)
- Bipolar disorder associated with high levels of unemployment
- 120 patients with bipolar disorder
- Looked at predictors of occupational status
=>demographic factors, clinical characteristics, IQ and executive function
=>Executive functioning was a more powerful predictor of occupational status than IQ, demographics and clinical factors, including illness severity.
types of executive function
planning
- decide goals, execute and adapt plans
- eg shopping, cooking, many work task
initiation, monitoring and control
- inhibition and switching, apathy
- eg driving, self care, working
socioemotional control
- regulating mood and social behaviour
- eg social interactions, maintaining relationships, working
measuring executive function
- neuropsychological tests
- structured interviews
- rating scales
- behavioural assessments
Issues in assessing executive functions (EF)Burgess & Alderman (2013) Chapter 9 in Goldstein & McNeil.
Traditional psychometrics may not apply
-EF tasks must be novel: test-retest reliability?
-EF tasks must be unstructured: reliability lower?
ecological validity important
- Naturalistic/complex settings: norms don’t apply
- Instructions less directive
executive function tasks dissociated
- poor convergent validity
