Neuropsychological Assessment Flashcards
What is the purpose of neuropsyhcological assessment?
Clinical purposes are unique to imaging
Assist with diagnosis (onset & course)
Comprehensive description of cognitive abilities
Monitor recovery, course and effects of treatment
Guide treatment/management (detect tumour recurrence and onset of dementia before imaging can, assist surgery for epilepsy)
Understand everyday effects of brain damage or illness and support the person and their family
What is neuropsyhcological assessment?
A set of tools used to assess the cognitive, behavioural and emotional effects of a known/suspected neurological disorder
Interview (pre-illness history, symptoms, coping and adjustment)
Cognitive tests (IQ, language, attention, memory, perception, executive function)
Self-report and relative reports on questionnaires
Behavioural observation – mental status exam
Feedback and report to guide rehabilitation
What to screen for prior to commencing testing?
Alcohol and drug use
Adequate sensory function (e.g., need for aids)
Perceptual deficits (neglect, agnosia etc)
Physical factors (low arousal, fatigue, pain, prescription medication, motor impairment)
Receptive and expressive English language (aphasia, CALD populations)
Emotional and motivational issues (anxiety, ↓ effort)
Psychosis or perceptual disturbances
Are some tests inappropriate – are there other options (e.g., non-verbal tests of IQ)
Language =(1st language/cultural differences)
Conetration (Fatigue)
Comprehension
Motivation and effort (Motivational problems? mood disorder? motivated to perform badly)
How to interpret test performance?
An individual’s performance on cognitive tests is reported in percentiles and/or qualitative descriptions of ability relative to age norms or specific test norms
How to estimate premorbid IQ
Demographic, educational and occupational details
WAIS-IV/WISC-IV profile (use of appropriate subtests)
- Provides global summary of a person’s general cognitive ability which encompasses 4 domains:
–Verbal comprehension (vocabulary, general knowledge, abstract reasoning and social judgment);
–Perceptual organisation (visuo-spatial analysis, sequencing, construction and problem-solving)
–Processing Speed (visual tracking and motor speed)
–Working memory (attention, concentration and memory)
Academic achievement (WRAT/WIAT)
Verbal: Word pronunciation (NART/WTAR)
Nonverbal: Ravens Matrices, Peabody Picture Vocabulary Test
What assessment to use for Culturally & Linguistically Diverse IQ?
Wechsler Nonverbal Scale of Ability (full/brief) -Matrices -Object Assembly -Coding -Recognition -Spatial Span -Picture Arrangement Suitable for people from culturally and linguistically diverse background and people with hearing and language impairments
Assessment of Attention and Concentration
Multi-level skill area ranging from basic to complex which mediate other cognitive processes Includes: Basic arousal Sustained attention Selective attention Alternating attention Divided attention
Assessment of Attention and Concentration
Arousal and Alertness
Level of alertness, receptiveness or ability to respond to the environment at a basic level. Problems may be indicated by:
Yawning, falling asleep, inability to wake or alert oneself, disinterest in tasks and low motivation.
Slow and inconsistent performance due to fluctuating alertness.
Difficulty increasing alertness in response to internal or external cuing with little increase in performance to demands.
Assessment: behavioural observation
Assessment of Attention and Concentration
Sustained Attention
Ability to maintain concentration or focus towards stimuli over a given time frame. Often referred to as ‘vigilance’
Problems evident by: decreased alertness and responsiveness over time, losing train of thought or the focus of attention wanders
Assessment:
ability to focus on a repetitive and monotonous task over an extended period (continuous performance tests of counting or detecting targets, Elevator Counting on the Test of Everyday Attention)
Self-report or relative’s report during interview.
Assessment of Attention and Concentration
Selective Attention
Ability to focus attention on a stimulus and ignore irrelevant internal or external stimuli
Problems indicated by: distractibility or difficulty disengaging from competing environmental stimuli (auditory or visual)
Assessment:
behavioural observation (is the person easily distracted?)
various cognitive tests (Map Search & Elevator Counting With Distraction, Test of Everyday Attention).
Self versus relative report
Assessment of Attention and Concentration
Alternating Attention
The ability to shift the focus of attention from one aspect of a task to another (switching) – also related to mental flexibility
Problems evident by:
the person getting stuck on one task and neglecting others or starting tasks, leaving them and failing to return to complete them
Assessment: Tasks which require the person to shift smoothly from one aspect of a task to another (Visual Elevator of the TEA, Trails B)
Interview, observation and relative’s report
Assessment of Attention and Concentration
Divided Attention
The ability to attend or respond simultaneously to more than one task or stimulus * potential risks
Problems evident by: a person
saying they cannot juggle tasks
and need to do one thing at a time
Assessment: measures of dual-task ability (e.g. counting tones and detecting visual targets) that require simultaneous responses.
interview, observation and relative’s report
Assessment of Memory
Behavioural observation and interview
Self-reports and relative reports (EMQ)
Wechsler Memory Scale-IV: Norm-based tests to cover broad areas of memory ability (i.e., immediate versus delayed memory)
Word lists: Benefits of repetition and cues
Recall versus recognition
Rivermead Behavioural Memory Test, CAM-Prompt (Prospective Memory)
Remote memory (Autobiographical Memory Questionnaire)
Assessment of Language
Aphasia: a loss or decline in receptive or expressive language skills
Problems with comprehension, grammar, naming, repetition, fluency or word finding
Literacy skills, reading, spelling and writing
Language pragmatics (goal-directed use of language) or conversational skills (i.e awareness of rules, flow and context)
Right hemisphere is involved in intonation/prosody, humour, metaphor, sarcasm (interpreting the emotional meaning)
Assessment:
Behavioural observation in a natural setting (higher level language problems can be more subtle); Interviews and self-report/relatives’ reports;
Roleplays (note difference between structured and spontaneous speech);
Boston Diagnostic Aphasia Exam, verbal fluency, reading, spelling, vocabulary, Silly Sentences
Social perception: The Awareness of Social Inference Test (TASIT); reading social cues
Naturalistic tasks (i.e. write a letter, develop a shopping list, make a telephone call)
Assessment of Visuo-Spatial Skills
A complex neural network involving the eyes, optic nerves, pathways, cerebral cortex and cranial nerves work together to process visuo-spatial information.
Disorders affect the ability to:
- Recognise objects, drive, recognise faces, locate objects in space, negotiate stairs, pour a drink, write and draw
Sensory versus perceptual (check visual acuity)
Occipital lobe and right hemisphere – especially parietal (where) and temporal (what) lobes
Phenomenon of unilateral neglect and agnosia
Assessment:
examination of basic sensory functions is often done from the outset (asking is not enough);
Medical reports (parietal, temporal or RH damage?);
Interview with person and family member;
Behavioural observation during everyday tasks (look for avoidance and use of compensation);
Tests: line bisection and orientation, left-right orientation, clock/bicycle drawing tests, construction tests (blocks), embedded figures, Grooved Pegboard, complex figure and map reading
