Neuropsychological Assessment Flashcards
Neurological assessments
focus on intactness of lower-level functions
o e.g. motor system, sensory system, reflexes, etc
Neuropsychological assessments
focus on integration of higher-level cognitive processes
o e.g. language, memory, planning, etc.
neurological vs neuropsychological
Even in cases with clear brain disease or trauma
* Effects of cerebral damage may not be readily apparent
* More subtle effects are seen in defective performance on neuropsychological
tests
Brain damage may be apparent in neuropsychological assessment but not
neurological (and vice versa)
Neurological examination
Clinical history
- Mental status examination
—- quick appraisal of current level of functioning - appearance, attitude, behaviour, affect - what are they talking about, following conversation - how the damage is playing out - Assessment of cranial nerves
–Optic nerve - visual acuity assessed by an eye-chart - snell and letters eye chart
Follow finger, response to light - Motor functions (e.g. tone, strength, reflexes)
- Coordination
- Finger to nose test - alternate , eyes open then second time closed
- Sensory functions
–Temperature pain, needle, safety pin - can you feel this - Gait
–Walk in a straight line - rate of walking - Diagnostic procedures (e.g. CT, MRI, PET, EEGs, etc.)
–Neuroimaging
Hard signs of neurological damage
Fairly definitive indicators of cerebral dysfunction; localized neurological damage
o e.g. damage to cranial nerves
o e.g. lesion to motor cortex supplying
movement of the foot
- Usually corresponds to with other independent evidence of brain damage (e.g. abnormalities on CT scans)
Soft signs of neurological damage
Non-localized neurological damage
o e.g. mental activities
o e.g. coordination and sensation
- More complex behaviours
o e.g. poor balance, impaired fine motor
coordination, clumsiness, inability to
perform rapid alternative movement of
hands
Neuropsychological examination
Sensory perceptual functions (tactile, visual,
auditory, etc.)
* Motor functions related to speed and strength
* Attention and problem-solving skills
* Language and communication skills
* Learning and memory skills
* Executive functioning
- Can be assessed with:
- A fixed battery
- A flexible battery
Neuropsychological examination
Motor functions related to speed and strength
STRENGTH
EYEHAND COORD
SPEED
Strength
- Dynamometer
Eye-hand coordination
- Grooved pegboard
Speed
- Finger tapping
- Index finger of each hand
Neuropsychological examination
Attention and problem-solving skills
Tests that assess:
- Concentration
- Attention span
- Alternating attention
- Processing speed
Trial making test - draw line to connect the numbers - - concentration, attention span, alternating attention, processing speed
Ruff 2&7 - cross out 2’s and 7’s
Neuropsychological examination
Language and communication skills
PPVT -Peabody Picture Vocabulary Test - receptive language vocab - picture point to banana
Token test - oral demands that increase in complexity - pick up the red one and point to the green one - multiple instructions
Boston naming test - name items presented visually
Neuropsychological examination
Visual-spatial and constructional skills
Bender-Gestalt
— nine index cards picturing different geometric designs. The cards are presented individually and test subjects are asked to copy the design
Arrows subtest
(NEPSY-II)
–The child looks at an array of arrows arranged
around a target and indicates the arrow(s) that points to the center of the target
Block Design - blocks resemble picture
Neuropsychological examination
Learning and memory skills
Rey Complex
Figure - copy that crazy ass figure
Hopkins Verbal
Learning Test -test consists of three trials of free-recall of a 12-item, semantically categorized list, followed by yes/no recognition
Neuropsychological assessment
* Executive functioning
Wisconsin Card Sorting Task - Stimulus cards are shown to the participant and the participant is then instructed to match the cards.[3] They are not given instructions on how to match the cards but are given feedback when the matches they make are right or wrong
Tower of Hanoi - move the entire stack to one of the other rods, obeying the following rules
Examining test results
- Level of performance
* Involves comparing the child’s test scores with cutoffs or values from a normative
sample
* Useful to have status prior to injury - Pattern of performance
* Engage in profile analysis examining the various subdomains - Look for pathognomonic signs of brain injury
- Performance differences according to laterality / localization / functional deficits
Why do so many neuropathological
conditions result in..
Emotional dysregulation
* feelings of depression or anxiety, sadness,
more emotional than usual, irritability
Cognitive deficits
* difficulty concentrating, poor working memory,
trouble shifting attention
Behavioural changes
* impulsivity, tendency to have emotional
outbursts, tiredness
Example conditions: Alzheimer’s disease, Parkinson’s disease, depression, and
anxiety
