Neuropsychological assessment

Question 1

what does neuropsychology do?

Answer 1

examines the relationship between behavior and the function and structure of the brain (what happens in the brain)

Question 2

what are the two types of samples in neuropsychology?

Answer 2

1. clinical: focused on patients, e.g. lesions

2. experimental: typical and non-typical behavior

Question 3

What is the aim of a (Double) dissociation?

Answer 3

• ‘gold standard’ in neuropsychology
• Minimum regions (small as possible to really locate the region that is involved in a cog. Process)
• localisation of function: damage in a specific area lead to certain behavioral deficits, e.g. Phineas Gage: prefrontal cortex: self regulation problems
• -> show that one brain area is responsible for one specific function

Question 4

What is a single dissociation?

Answer 4

damage to brain area 1 results in function A being disrupted, but function B is intact
e.g. all patients with damage in the Wernicke areal had problems understanding speech, but could still produce it

Question 5

What is a double dissociation?

Answer 5

need to find that that damage to area 2 leaves function A intact, but function B is disrupted
e.g. all patients with damage in the Wernicke areal had problems understanding speech, but could still produce it PLUS all patients with damage in the Broca areal had problems producing speech, but could still understand it –> there are two independent areas in the brain, one responsible for producing speech, the other for comprehending

Question 6

study example double dissociation

Answer 6

Cognitive vs. emotional empathy: Can you have a deficit in one, but not in the other?
- They found patients who had lesions either in the inferior frontal gyrus which is thought to be involved in affective empathy or in the ventromedial prefrontal gyrus (cognitive empathy) and then they had a comparison group who did have lesions but not in the PFC

Question 7

Problems with lesion methods

Answer 7

1. variations between patients: lesions vary in extent and origins, small sample sizes (-> You cannot ethically induce a lesion in someone or control where the lesion is and therefore pp are difficult to find), environmental factors, cognitive differences between patients (There may have been differences in the abilities/functioning of the patients before they have had a lesion)
2. involves interpretation of non significant results: absence of an effect is not the best proof that this effect does not actually exist
3. site may be critical, but other areas may also be involved (networks)

Question 8

Goals of NP assessment

Answer 8

1. determine spared vs. impaired abilities (questionnaires, observations, neuropsychological tests)
2. understanding impact of injury and/or (neuro)developmental problem
3. generate suggestions for remediation and compensation

Question 9

domains of NP functioning

Answer 9

1. motor
2. sensory perception
3. visual processing
4. attention
5. language
6. memory and learning
7. executive functions
   related domains:
8. intelligence
9. achievement
10. motivation
11. social-emotional
12. family/school/work environment

Question 10

sky search (TEA-CH)

Answer 10

• outcome measures: time taken and accuracy
• examines attention and visual selection through substraction –> 1st sheet: circle space ships, motor task, 2nd sheet: circle space ships pairs that are the same (actually the ones that were circles beore), more complicated –> how long does each one take? –> substract –> correct for motor skills (lower order abilities)
• If it is a lower order problem you can already see it in the first part of the task whereas if it is a higher order problem you would see it only in the second part of the task.

Question 11

letter digit substitution task or symbol-digit modalities task

Answer 11

• outcome measure: number of correct items - errors = raw score
• examining visual search, memory and processing speed
• predicts automaticity, fluency and variability in cognitive performance

Question 12

Five-point test/ design fluency

Answer 12

• outcome measures:
  1. number of figures
  2. errors/perseverations
  3. strategies use
• examines motor skills, memory and executive functioning (self-monitoring, strategy use and shifting)

Question 13

trail making task (TMT)

Answer 13

• outcome measures:
  1. speed
  2. errors (perseverations, impulsivity)
• examines motor speed, attention, visual scanning, switching (B-A)

Question 14

D2 test of attention

Answer 14

• outcome measures
  1. omissions
  2. commission errors
  3. total number of precessed items
  4. fluctutation rate
• examines selective and sustained attention

Question 15

Experimental NP tasks (problems)

Answer 15

• If you administer these tests to healthy controls (adults or children) they mostly perform quite well on those tests. However, when we are doing research, we are interested in variance in our group and if everyone in our sample does so well on the task it is not that interesting for research.
• many clinical tasks are not directly suitable for use in healthy samples due to:
  1. ceiling effects
  2. low sensitivity
  3. practice effects (when measuring treatment outcomes)
  4. practical limitations of testing environment (scanner, schools…)
  5. confounding of higher and lower order processes

Question 16

how can experimental NP tasks be adapted? (e.g. for control groups)

Answer 16

• parallel tests
• 2nd baseline measurements (2nd measure at baseline)
• reaction times are often more sensitive than behavioral measures
• increased complexity = increased sensitivity (Although everyone might perform quite well on a 1-back task when you have to press the button if the previous stimulus was a t for example, it might be ok. But if you say that 4-back was a t, that becomes a lot more difficult. In a patient sample a 1-back or 2-back task might be sufficient whereas in a TD sample a 4-back might be more suitable. )

Question 17

why do tasks require adaptations for neuroscience studies and which ones?

Answer 17

1. fMRI tasks: control for movement, e.g. by using non-verbal categorical answers, standardised pacing of task
2. control condition is important (People sometimes just use a resting-state which does not work because now we know that there are specific areas active whenever we rest. Meaning that now you are not comparing to a state in which they do nothing, rather you think or do something you have no control over. Instead, pp should do a very similar task - making it visually the same but they randomly push a button for example (then you still have the button pushing and the looking at the screen aspect))
3. lower order processes influence higher order processes
4. important to consider heterogeneity within control group

Question 18

lower and higher order processes

Answer 18

• lower order processes influence higher order processes:
  1. many aspects of cognition influence lower order skills which confounds examination of higher order abilities
  2. important to consider task demands and possible covariates (potentially include additional conditions/measures) e.g. Sky search task

Question 19

important to consider heterogeneity within control group

Answer 19

Fair study:

• both ADHD and control groups consisted of similar unique subtypes (unrelated to severity)
• comparisons within subgroups increased diagnostic accuracy –> heterogeneity within patients is ‘nested’ in normal variation in control group

Question 20

study: double-dissociation between the mechanisms leading to impulsivity and inattention in ADHD: a resting-state functional connectivity study

Answer 20

• brain network activity differences in different subtypes of ADHD (inattentive, hyperactive/impulsive, combined) –> double dissociation between specific networks associated with hyperactivity-impulsivity and inattentiveness

Question 21

study: distinct neuropsychological subgroups in typically developing youth inform heterogeneity in children with ADHD

Answer 21

• although same disorder: individuals heterogenious and overlap with neurotypicals
• use of graph theory to identify clusters of individuals (what do they have in common? neuropsychological correlations) –> subtypes show different symptoms