Neuropsychological assessment

Question 1

Purpose of the examination

Answer 1

• Alternative to brain imaging
  a) Differential diagnosis: Which of two or more diagnostic categories best suits the patient’s behaviours
  b) To assess what skills are intact; can enable us to see what general skills are intact to help us test
  c) May actually be a physical problem which is manifesting psychologically (i.e. fatigue from diet)

Question 2

Examiner background (2)

Answer 2

• need to avoid their biases

- need to regularly update their knowledge

Question 3

Patient’s background

Answer 3

1) Social History
- educational background (qualities and abilities)
- SES
- Life events
- Medical history and current medical status

Question 4

When to examine

Answer 4

• Sudden onset conditions might need an immediate assessment (if you did have neuroimaging equip you’d want to know the extent of the impairment asap)
• acute/post-acute stages = A full neuropsychological assessment should not be undertaken until the patient’s condition has been stabilized

Question 5

Selecting test

Answer 5

• Test validity:
  a) FACE VALIDITY - does it really test what it says it does
  b) Ecological validity – how well the tests reflect real life tasks?
  c) Reliability: is it consistent across markers

Question 6

Computerised tests

a) Advantages
b) Disadvantages

Answer 6

Advantages
– Good at standardized task administration; easy to get data etc/ good for RT (easy way to get this information)
– Accurately recording response times
– Can vary level of difficulty (easy to construct scenarios)
Disadvantages
– Rely on computerized behavioural responses (more difficult to include verbal responses, physical gestures) – more difficult to inc verbal responses. Limited – one 2D info about their behaviour  limited to motor respons enad attentional processes; any gross motor tasks are hard to achieve by these tests & language abilities
– Weak ecological validity – poorly mimics social interaction
– Technological bugs, operating system failure

Question 7

NEED TO CONSIDER

Answer 7

1) Task difficulty –> Lend self to diff levels of difficulty; some just start off very difficult.
2) Sensitivity –> How many people with a particular disorder perform poorly on a given test & how many different types of people are likely to perform poorly on test
3) Specificity –> – How well can it eliminate one disorder from another disorder?

**How many are diagnosed vs misdiagnosed

Question 8

Double Dissociation

Answer 8

when two related mental processes are shown to function independently of each other.

If a type of performance error on one task is different from the type of performance error on another task, this would suggest double dissociation

Question 9

Qualitative data

Answer 9

a. Examiners can provide additional context to patient behaviour besides the actual scores on the task
b. Documenting and communicating the complexity, variability, and subtleties of patient behaviour

Problems with quant data –
– Distortion of information obtained; misinterpretation of performance on test If inexperienced
– Affects validity and reliability of tests
– Communication difficulties between examiner and client

Question 10

Quantitative data

Answer 10

1) Assumes there are discrete outcomes (left cortical lesion, right cortical lesion, diffuse damage, no damage) – categorical response
2) The scores generated from the test defines a narrow set of behaviours
3) Satisfies the need for objective, readily replicable data that permits reliable interpretation

Problems with quant data:

• The test score is abstract and artificial
– Can result in incorrect interpretations and conclusions

• If a score is derived from a complex multidimensional task, then difficult to know what functions are contributing towards it; Restricted information – hard to know what functions are contributing

• Same applies to a battery of tests (e.g. Wechsler Memory scale)
– Two people can get the same score for different reasons