Neuropsychological assessment Flashcards
What is Neuropsychological assessment?
aims to understand and quantify functional deficits after brain injury
What is the purpose of it?
Understand and quantify the effects of brain damage on intellectual, motor, and emotional functions.
It is administered by a neurologist, neuropsychologist, other clinician
What do clinicians do? (neuropsychological assessment)
- They make recommendations for therapy/treatment/management
- Track progress in therapy, or with neurodegenerative disorders
- Profiling of strengths and weaknesses (what they can and can’t do)
- Can also be used in legal settings and educational settings (with children)
What is a Standardised procedure?
Test administers should follow standardised procedures and instructions.
- Training is necessary for the examiner
- Like psychological experiments, the experimenter/examiners behaviour and or instructions could influence behaviour
What is a fixed battery?
A series of comprehensive neuropsychological tests administered to all individuals.
What is Flexible Testing?
A more individualised selection of tests, dependent on the reason for neuropsychological assessment.
Standardised testing?
Most fixed batteries are standardised, meaning they’re administered in the same standard way to all participants. Everyone is instructed to do the same thing in the exact same way.
What is the difference between a test and an assessment?
A test aims to sample behaviour or a skill/ability. (refers to standardised testing for instance)
Assessment is the interpretation of performance.
What are some examples of test batteries?
Halstead-Reitan Battery - standardised
- Assesses brain dysfunction
- The HRNB is a compilation of neuropsychological tests designed to evaluate the functioning of the brain and nervous system in individuals aged 15 years and older.
CANTAB - computerised
- CANTAB accurately measures cognitive function, identifies levels of performance and impairment, and quantifies the effectiveness of treatments in the brain.
- The CANTAB has modules for several neurocognitive functions and processes including psychomotor and motor speed, reasoning and planning abilities, memory and attention, and frontal, temporal and hippocampal dysfunctions.
CASE STUDY: RICHARD
Richard, 52, male
- Suffered a brain injury due to a car accident (6 months ago)
- He has no memory recollection of the accident
- Difficulty with remembering things
- Sometimes, his behaviour is rigid for example, he will repeat behaviours such as constantly trying an incorrect key in a door, often finding it difficult to stop
A neuropsychologist might ask him to complete the Wisconsin Card Sorting test (WCST)
Wisconsin Card Sorting test (WCST) measures executive functioning, which measures one’s ability to develop abstract concepts (abstract reasoning) and shift between sets (mental or cognitive flexibility and problem solving)
Richard might have difficulty with the WCST test
- He might have difficulty switching the rules, might get stuck on the same set
- His performance accuracy would be low
Traditional vs Online testing (advantages and disadvantages)
Traditional testing
Key advantages:
- easily portable (limited equipment needed)
- greater engagement with participant
- can be easily adjusted in real time
Key disadvantages:
- costly and time consuming
- specialist training needed for the researcher/ clinician
- Increased risk of human error
- Scoring can be consuming
Computerised/Online testing
Key advantages:
- Precision scoring and timing
- Entirely standardised administration
- Usually less costly
Key disadvantages:
- Experience with computer interface needed
- Not as flexible
- Need for specific hardware/software
- Programming skills (for designing tests)
What can influence test performance?
1.Brain Injury
For example, someone with aphasia (language impairment) cannot name objects after having a stroke
2.Co-contaminant impairment/overlap of function
Sometimes multiple functions can be impaired
We want the test to be valid
For example, someone with aphasia (language impairment) cannot complete a digit span task i.e., repeating numbers to test short-term or working memory
3.Task Difficulty
This is a problem
Some tests can be complex, and explaining instructions to participants can be challenging
We want to rule out this as a cause of poor performance
For example, an elderly participant who has no history of brain injury scores poorly on the Wisconsin Card Sorting Task. Afterwards, they mentioned they did not properly understand the instructions
4.Factors: premorbid abilities, healthy ageing, undiagnosed disorders, education, culture, individual differences
In neuropsychology, we rarely have a pre-morbid baseline (score before brain injury)
Some tests are sensitive to ageing, and often early stages of dementia (undiagnosed) could be an issue
For example, a participant with brain injury scores poorly on a reading task. A family member comments that the participant had dropped out of school very early and has always had difficulty reading
Possible solutions:
Select tests carefully use screens to check basic cognitive skills (adapt tasks if necessary but be extra careful with interpretation, collect new normative data for adapted tasks.)
Provide standardised and clear instruction, practice items could help (avoid too many)
